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  • mstrong
    Member
    Post count: 5

    Hi Dr.

    I’m 38 year old male and I’ve been dealing with lower back issues on and off for several years now. I started getting Sciatica-like symptoms in the fall. Just got my CT results today.

    My diagnosis is:

    ~ L4-5: Concentric Disc bulging with a moderate sized superimposed left paracentral disc protrusion.

    ~ L5-S1: No disc protrusion or spinal stenosis. The L5 vertebra is transitional, showing a transverse process on the left and partial sacralization on the right.

    The Osteopath I have been to has said “No more” to the following: olympic lifting, multi-day treks with a back pack and anything else that puts load on my spine greater than 25-30 lbs. Of course, these are all things I love to do.

    My question is, is there a possibility that the partial sacralization of L5 can be categorized as Bertolotti’s syndrome? If so, should I be asking for a second opinion and potentially look at surgery to perform a resection of this transitional articulation?

    Thank you very much for looking at this.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8460

    Your L5-S1 level is partially sacralized. This means that way back in utero, your L5 couldn’t make the decision “should I be a vertebra or should I be part of the sacrum”. It decided to be a bit of both. Rest assured that this level is very highly unlikely to be a problem to you. That transverse alar articulation on the right should be very strong and actually prevent stress on the L5-S1 disc. This is why the report did not mention any discal degeneration of the L5-S1 disc.

    The report does note that the L4-5 disc is degenerative and a disc herniation is present to the left. This is to be expected with no motion of the L5-S1 level with the stress then brought to the L4-5 level.

    Bertolotti’s syndrome is exactly what you have here but I don’t like to use that term as it is confusing to many care-givers. I have seen probably 300 transverse-alar articulations or transverse fusions and have only found one of all of those that was painful and needed resection. This condition is found in many professional athletes and causes them no problem.

    Now, your disc herniation at L4-5 is another matter but that needs to be treated appropriately conservatively as long as you have no motor weakness (this would be noted as footdrop or ankle weakness).

    My patients with this disorder can weight lift and backpack understanding the risks of these activities.

    Dr. Corenman

    mstrong
    Member
    Post count: 5

    Thank you very much for the quick reply, Dr. Coreman.

    So, what I am reading is that irregular mechanics, due to the L5-S1 articulation, likely led to the degeneration and herniation of L4-5?

    With regard to a conservative approach to disc herniation, do you typically suggest physiotherapy? And is this something I can expect to ever fully get past? I’ll do whatever is required and spend whatever is required….I just don’t want to stop being active! I want to be able to keep up with my kids and one day, their kids.

    Thanks again for explaining my diagnosis.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8460

    The L5 vertebra does not move due to the transverse-alar articulation. This transfers the stress to the L4-5 level. The L4-5 herniation is not “due” to the L5-S1 “fusion” but is an unfortunate sequella of your genetics and activities and any prior trauma.

    Disc herniation treatment starts with a good rehab program. Depending upon the severity of symptoms, an epidural can also be effective.

    Dr. Corenman

    mstrong
    Member
    Post count: 5

    Thanks Dr.

    I really appreciate you sharing your knowledge and your time.

    All the best.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8460

    My pleasure.

    Dr. Corenman

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