801 - Cryoablation as a treatment for symptomatic Bertolotti’s syndrome: A case report

Case Diagnosis: Bertolotti’s syndrome causing chronic lower back pai

Case Description: A 44-year-old female with a 25-year history of intermittent lower back pain presented to our clinic with progressive worsening of her symptoms over the past 5 years. CT scan confirmed the diagnosis of Bertolotti syndrome with partial sacralization of left L5 transverse process. A diagnostic block was performed and complete pain relief lasted for a few hours. Subsequently a radiofrequency ablation of left iliolumbar ligament was performed with only one week of pain relief. A subsequent trial of cryoablation of the iliolumbar ligament was performed and she reported 4 months of substantial pain relief before gradually returning to baseline levels. A second cryoablation with a different approach was performed, with tip being directed above and below iliolumbar ligament and the junction between the ligament and the ilium. Patient reported almost complete pain relief that lasted 6 months .

Discussions: Bertolotti’s syndrome is characterized by chronic low back pain caused by transitional lumbosacral vertebrae with a reported incidence of 4-36%. Initial management are usually conservative including physical therapy and medical management. Should conservative management fails, surgical treatment is the mainstay management. Interventions such as radiofrequency (RF) ablation may have a role but there has not been any reported use of cryoablation for the management of symptomatic Bertolotti’s syndrome.

Conclusions: We suggest that cryoablation is an effective option in refractory symptomatic Bertolotti's syndrome. Further investigation of this technique is warranted