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Bertolotti's syndrome is characterized by sacralization of the lowest lumbar vertebral body and lumbarization of the uppermost sacral segment. It involves a total or partial unilateral or bilateral fusion of the transverse process of the lowest lumbar vertebra to the sacrum, leading to the formation of a transitional 5th lumbar vertebra.
The sciatic nerve forms the roots of L4-S3 segments of the lumbosacral plexus. The nerve will pass inferiorly to the piriformis muscle, in the direction of the lower limb where it divides into common tibial and fibular nerves. [7] Symptoms may include pain and numbness in the buttocks and down the leg.
This nerve irritation causes referred pain in a well described tri-branched pattern. The diagnosis is made clinically with the variable presence of four criteria. Descriptions of clinical involvement of posterior rami were found as early as 1893, but not until 1980 that LDRS was so precisely described.
The pain is characteristically described as shooting or shock-like, quickly traveling along the course of the affected nerves. [12] Others use the term as a diagnosis (i.e. an indication of cause and effect) for nerve dysfunction caused by compression of one or more lumbar or sacral nerve roots from a spinal disc herniation. [4]
Therefore, a combination of signs and symptoms may be more helpful in diagnosing NC than any single feature of the history or physical exam. These signs and symptoms include pain triggered by standing, pain relieved by sitting, symptoms above the knees, and a positive "shopping cart sign". [4] Specific questions that may aid diagnosis include: [10]
The syndrome occurs in 12% of older community-dwelling men [3] and up to 21% of those in retirement communities. [4] Because the leg symptoms in lumbar spinal stenosis (LSS) are similar to those found with vascular claudication, the term pseudoclaudication is often used for symptoms of LSS. [5]
The fifth lumbar spinal nerve 5 (L5) [5] originates from the spinal column from below the lumbar vertebra 5 (L5). L5 supplies many muscles, either directly or through nerves originating from L5. They are not innervated with L5 as single origin, but partly by L5 and partly by other spinal nerves. The muscles are: gluteus maximus muscle mainly S1
Dysfunction of the superior cluneal nerves lead to many different neuropathic symptoms such as burning pain, numbness, tingling, and dysesthesia around the low back and upper gluteal area. The most common symptoms are localized unilateral low back pain, though up to anywhere between 40 and 82% of patients may complain of leg symptoms – pain ...