804 - The Unique Case of Genital Pain in Bertolotti Syndrome

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

Dylan W. Banks, MD

Resident
New York University, PM&R Residency
New York, New York, United States

Co-Author(s)

NM

Nathan Michalak, MD

Resident
New York Medical College, Metropolitan PM&R Residency
New York, New York, United States
JS

Jason Siefferman, MD

Clinical Assistant Professor, Department of Anesthesiology Division of Pain Medicine
New York University
New York,, New York, United States
LK

Luke Kane, DO

Clinician
Manhattan Pain Clinic
New York, New York, United States

Case Diagnosis: Bertolotti Syndrome

Case Description: A 68 year-old female presented to a pain clinic with over 30 years of right-sided vulvodynia extending to her rectum. She had previously received years of pelvic physical therapy, multiple oral and topical medications, in addition to pudendal nerve and ganglion impar blocks which were diagnostically negative. X-ray of the pelvis revealed a lumbosacral transitional vertebrae with peaked sacral alae and contact between the L5 transverse process and the ala on the right side (Figure 1). A fluoroscopically guided diagnostic injection of lidocaine into the site of interaction between the transverse process and the ala resulted in 60-70% reduction in vulvodynia for 1 hour. This was the first and only procedure in her 30 years of pain that she felt 'hit the spot.'

Discussions: Bertolotti Syndrome includes clinical symptoms resulting from a transitional lumbosacral vertebrae. This segment may alter pelvic biomechanics and may contain a rub site between the enlarged transverse process and the sacral ala and/or ilium. It is known to exist anatomically in up to 36% of the population and may present with a wide variety of symptomatology including back, groin and leg pain. While this patient reported symptomatology that coincides with pudendal neuralgia, typical treatment methods for pudendal neuralgia failed to provide relief. We present the first reported case of genital pain attributed to Bertolotti Syndrome.

Conclusions: Bertolotti Syndrome may be considered as a possible source of pain referring into the genitals.