Quality-of-life and postoperative satisfaction following pseudoarthrectomy in patients with Bertolotti syndrome

Abstract

Background context: Bertolotti syndrome is a clinical diagnosis given to patients with back pain arising from a lumbosacral transitional vertebra (LSTV). A particular class of LSTV involves a pseudoarticulation between the fifth lumbar transverse process and the sacral ala, and surgical resection of the pseudoarticulation may be offered to patients failing conservative management. Bertolotti syndrome is still not well understood, particularly regarding how patients respond to surgical resection of the LSTV pseudoarticulation.

Purpose: To examine change in quality-of-life (QOL) and patient satisfaction following surgical resection of the LSTV pseudoarticulation in patients with Bertolotti syndrome.

Design: Ambidirectional observational cohort study of patients seen at a single institution's tertiary spine center over a 10-year period.

Patient sample: Cohort consisted of 31 patients with Bertolotti Syndrome who underwent surgical resection of the pseudoarticulation.

Outcome measures: Preoperative and postoperative Patient-Reported Outcomes Measurement Information System Global Health (PROMIS-GH) Mental and Physical Health T-scores, and a single-item postoperative satisfaction questionnaire.

Methods: Patients were identified through diagnostic and procedural codes. Immediate preoperative PROMIS-GH scores available in the chart were gathered retrospectively, and postoperative PROMIS-GH and satisfaction scores were gathered prospectively through a mail-in survey.

Results: Mean (SD) improvement of PROMIS-GH Physical Health T-score was 8.7 (10.5) (p<.001). Mean (SD) improvement of PROMIS-GH Mental Health T-scores was 5.9 (9.2) (p=.001). When stratifying PROMIS-GH T-scores by response to the patient satisfaction survey, there were significant group differences in mean change for Physical Health T-scores (p<.001), and Mental Health T-score (p=.009). Patients who stated, "The treatment met my expectations" had much greater mean improvement in the PROMIS-GH T-scores.

Conclusions: Patients undergoing a pseudoarticulation resection procedure may experience a significant improvement in quality-of-life as measured by PROMIS-GH Mental and Physical Health.

Keywords: Bertolotti syndrome; Low back pain; Lumbosacral transitional vertebra; Pseudoarticulation.