Lumbosakral Transizyonel Vertebra ve Bertolottı Sendromu: Bel Ağrısının Sık Ancak Atlanan Bir Nedeni
Özet
Lumbosakral transizyonel vertebra (LSTV), %7 ila %32 görülme sıklığına sahip doğumsal bir anatomik varyant olup son lomber vertebranın transvers prosesinin genişleyerek sakrum ile ilişkilendiği geniş bir spektrumu tanımlar. Genetik bileşenlerin yanı sıra sakroilyak eklemdeki yük aktarımından etkilenen bu durum, özellikle tek taraflı olgularda pelvik dizilim bozukluğuna, skolyotik eğrilere ve transizyon düzeyinin hemen üzerindeki segmentte faset eklem ile disk dejenerasyonlarına yol açabilir. Tanısında standart olarak Ferguson grafileri kullanılırken, morfolojik özelliklerine göre Castellvi (Tip 1-4) ve O’Driscoll sınıflamaları mevcuttur. LSTV ile ilişkili bel ağrısı ilk kez Bertolotti tarafından tanımlanmış olup psödoartroz artriti, osteofitlere bağlı sinir kökü basısı veya komşu diske binen yükün artmasıyla ortaya çıkmaktadır. Klinik başvurularda semptomlar kötüleştikçe LSTV saptanma oranı artmakta, ayrıca genç hastalarda erken ve ağır disk dejenerasyonu ile herniasyon riskini tetiklemektedir. Tedavi yönetiminde ilk olarak nonsteroid antiinflamatuar ilaçlar (NSAİİ) ve fizik tedavi tercih edilirken, cerrahi seçenekler uzun dönem sonuçlarının net olmaması sebebiyle yalnızca tedaviye dirençli ve çok iyi seçilmiş olgularda düşünülmelidir.
Lumbosacral transitional vertebra (LSTV) is a congenital anatomical variant with an incidence of 7% to 32%, defining a wide spectrum where the transverse process of the last lumbar vertebra elongates and articulates with the sacrum. Influenced by genetic components and load transfer in the sacroiliac joint, this condition causes pelvic alignment impairment, scoliosis, and degenerative changes in the disc and facet joints immediately above the transitional segment, especially in unilateral cases. Standard Ferguson radiographs are utilized for diagnosis, and classification is based on Castellvi (Types 1-4) and O'Driscoll systems depending on morphological features. Low back pain associated with LSTV was first described by Bertolotti and originates from arthritis developing in the pseudoarthrosis, nerve root compression due to osteophytes, or increased workload on the adjacent cephalad disc. The incidence of LSTV increases as spinal symptoms worsen, and it triggers earlier and more severe disc degeneration and herniation, particularly in young patients. In conservative management, NSAIDs and physical therapy are the primary choices, whereas surgical interventions should remain an option only for highly selected, treatment-refractory cases due to the lack of consensus and unclear long-term outcomes in literature.
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