{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:06:04Z","timestamp":1776096364663,"version":"3.50.1"},"reference-count":32,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"8","license":[{"start":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T00:00:00Z","timestamp":1771804800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,2,23]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Bertolotti syndrome is characterized by low back pain and a lumbosacral transitional vertebra (LSTV). LSTVs are classified into four types by the Castellvi system. Pain is thought to be due to degeneration or strain at a pseudoarticulation of the enlarged transverse process and the sacrum. At times, patients with Bertolotti syndrome develop severe degeneration and\/or instability adjacent to the LSTV. Treatments range from conservative measures, such as therapeutic injections, to surgical interventions, such as fusion, resection, and decompression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>This study examines two-level fusion surgeries performed via open, minimally invasive (MIS), or robotic approaches for Bertolotti syndrome and associated adjacent level degeneration. Eight patients were identified retrospectively. All underwent two-level fusion at L4\u2013L5\u2013S1 or L5\u2013L6\u2013S1. Six surgeries were MIS (one with robotic assistance), and two were open. MIS\/robotic procedures had a median surgery duration of 3 hours 30.5 minutes and a median blood loss of 50 ml, while open surgeries averaged 5 hours 49.5 minutes, with 300 ml of blood loss. No patients had 90-day or 12-month readmissions or reoperations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Patients undergoing two-level fusion for Bertolotti syndrome had similar outcomes across surgical approaches. Both groups improved in physical health above the minimal clinically important difference.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE25551\">https:\/\/thejns.org\/doi\/10.3171\/CASE25551<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25551","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T11:47:10Z","timestamp":1771847230000},"source":"Crossref","is-referenced-by-count":0,"title":["Two-level fusion for Bertolotti syndrome and concomitant adjacent segment disease: patient series"],"prefix":"10.3171","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-8316-4160","authenticated-orcid":true,"given":"Jamie","family":"Sheehan","sequence":"first","affiliation":[{"name":"Ohio University Heritage College of Osteopathic Medicine, Dublin"},{"name":"Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8115-2262","authenticated-orcid":true,"given":"Seth M.","family":"Meade","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Lerner College of Medicine, Cleveland Clinic, Cleveland"},{"name":"Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9578-9458","authenticated-orcid":true,"given":"Hannah","family":"Lemel","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland"},{"name":"Case Western Reserve University School of Medicine, Cleveland, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1229-6852","authenticated-orcid":true,"given":"Aakash","family":"Shah","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland"},{"name":"Case Western Reserve University School of Medicine, Cleveland, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5992-705X","authenticated-orcid":true,"given":"Michael P.","family":"Steinmetz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Lerner College of Medicine, Cleveland Clinic, Cleveland"},{"name":"Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"bib1","article-title":"Bertolotti syndrome","author":"Miller","unstructured":"Miller AEZhang A.Bertolotti syndrome. In: StatPearls. StatPearls Publishing; 2024. Accessed March 2024. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK585032\/"},{"issue":"2","key":"bib2","series-title":"Orthop Rev (Pavia)","first-page":"24980","article-title":"A comprehensive update of the treatment and management of Bertolotti\u2019s syndrome: a best practices review","volume":"13","author":"Crane","year":"2021","unstructured":"Crane JCragon RO\u2019Neill JA comprehensive update of the treatment and management of Bertolotti\u2019s syndrome: a best practices review. Orthop Rev (Pavia). 2021;13(2):24980. doi:10.52965\/001c.24980"},{"issue":"10","key":"bib3","series-title":"Int J Surg","first-page":"3159","article-title":"A systematic review and bibliometric study of Bertolotti\u2019s syndrome: clinical characteristics and global trends","volume":"109","author":"Zhu","year":"2023","unstructured":"Zhu WDing XZheng JA systematic review and bibliometric study of Bertolotti\u2019s syndrome: clinical characteristics and global trends. Int J Surg. 2023;109(10):3159-3168. doi:10.1097\/JS9.0000000000000541"},{"key":"bib4","series-title":"Int J Spine Surg","first-page":"42","article-title":"A review of symptomatic lumbosacral transitional vertebrae: Bertolotti\u2019s syndrome","volume":"9","author":"Jancuska","year":"2015","unstructured":"Jancuska JMSpivak JMBendo JA.A review of symptomatic lumbosacral transitional vertebrae: Bertolotti\u2019s syndrome. Int J Spine Surg. 2015;9:42. doi:10.14444\/2042"},{"issue":"6","key":"bib5","series-title":"Pain Physician","first-page":"E923","article-title":"Decompressive L5 transverse processectomy for Bertolotti\u2019s syndrome: a preliminary study","volume":"20","author":"Ju","year":"2017","unstructured":"Ju CIKim SWKim JGLee SMShin HLee HY.Decompressive L5 transverse processectomy for Bertolotti\u2019s syndrome: a preliminary study. Pain Physician. 2017;20(6):E923-E932."},{"issue":"2","key":"bib6","series-title":"Arch Orthop Trauma Surg","first-page":"82","article-title":"Surgical treatment of Bertolotti\u2019s syndrome. Follow-up of 16 patients","volume":"112","author":"Santavirta","year":"1993","unstructured":"Santavirta STallroth KYlinen PSuoranta H.Surgical treatment of Bertolotti\u2019s syndrome. Follow-up of 16 patients. Arch Orthop Trauma Surg. 1993;112(2):82-87. doi:10.1007\/BF00420261"},{"issue":"9","key":"bib7","series-title":"J Gen Intern Med","first-page":"606","article-title":"The PHQ-9: validity of a brief depression severity measure","volume":"16","author":"Kroenke","year":"2001","unstructured":"Kroenke KSpitzer RLWilliams JB.The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-613. doi:10.1046\/j.1525-1497.2001.016009606.x"},{"issue":"1","key":"bib8","series-title":"Asian Spine J","first-page":"149","article-title":"Pelvic incidence as a determinant for chronic low back pain: few comments","volume":"9","author":"Ghobadifar","year":"2015","unstructured":"Ghobadifar MA.Pelvic incidence as a determinant for chronic low back pain: few comments. Asian Spine J. 2015;9(1):149-150. doi:10.4184\/asj.2015.9.1.149"},{"issue":"4","key":"bib9","series-title":"Control Clin Trials","first-page":"407","article-title":"Measurement of health status. Ascertaining the minimal clinically important difference","volume":"10","author":"Jaeschke","year":"1989","unstructured":"Jaeschke RSinger JGuyatt GH.Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials. 1989;10(4):407-415. doi:10.1016\/0197-2456(89)90005-6"},{"issue":"10","key":"bib10","series-title":"Clin Orthop Relat Res","first-page":"2027","article-title":"What are the MCIDs for PROMIS, NDI, and ODI instruments among patients with spinal conditions?","volume":"476","author":"Hung","year":"2018","unstructured":"Hung MSaltzman CLKendall RWhat are the MCIDs for PROMIS, NDI, and ODI instruments among patients with spinal conditions? Clin Orthop Relat Res. 2018;476(10):2027-2036. doi:10.1097\/CORR.0000000000000419"},{"key":"bib11","series-title":"J Clin Epidemiol","first-page":"200","article-title":"Effective dose 50 method as the minimal clinically important difference: evidence from depression trials","volume":"137","author":"Bauer-Staeb","year":"2021","unstructured":"Bauer-Staeb CKounali DZWelton NJEffective dose 50 method as the minimal clinically important difference: evidence from depression trials. J Clin Epidemiol. 2021;137:200-208. doi:10.1016\/j.jclinepi.2021.04.002"},{"issue":"3","key":"bib12","series-title":"Neurosurg Clin N Am","first-page":"323","article-title":"Spinopelvic parameters: lumbar lordosis, pelvic incidence, pelvic tilt, and sacral slope: What does a spine surgeon need to know to plan a lumbar deformity correction?","volume":"29","author":"Celestre","year":"2018","unstructured":"Celestre PCDimar JR II, Glassman SD.Spinopelvic parameters: lumbar lordosis, pelvic incidence, pelvic tilt, and sacral slope: What does a spine surgeon need to know to plan a lumbar deformity correction? Neurosurg Clin N Am. 2018;29(3):323-329. doi:10.1016\/j.nec.2018.03.003"},{"issue":"5","key":"bib13","series-title":"J Neurosurg Spine","first-page":"753","article-title":"Minimally invasive versus open lumbar spinal fusion: a matched study investigating patient-reported and surgical outcomes","volume":"36","author":"Mooney","year":"2021","unstructured":"Mooney JMichalopoulos GDAlvi MAMinimally invasive versus open lumbar spinal fusion: a matched study investigating patient-reported and surgical outcomes. J Neurosurg Spine. 2021;36(5):753-766. doi:10.3171\/2021.10.SPINE211128"},{"issue":"suppl 5","key":"bib14","series-title":"Eur Spine J","first-page":"564","article-title":"Pelvic parameters: origin and significance","volume":"20","author":"Le Huec","year":"2011","unstructured":"Le Huec JCAunoble SPhilippe LNicolas P.Pelvic parameters: origin and significance. Eur Spine J. 2011;20(suppl 5):564-571. doi:10.1007\/s00586-011-1940-1"},{"key":"bib15","series-title":"J Healthc Eng","first-page":"7069448","article-title":"Biomechanical effect of disc height on the components of the lumbar column at the same axial load: a finite-element study","volume":"2022","author":"Jeong","year":"2022","unstructured":"Jeong JGKang SJung GHBiomechanical effect of disc height on the components of the lumbar column at the same axial load: a finite-element study. J Healthc Eng. 2022;2022:7069448. doi:10.1155\/2022\/7069448"},{"issue":"12","key":"bib16","series-title":"Medicina (Kaunas)","first-page":"2112","article-title":"Does robotic spine surgery add value to surgical practice over navigation-based systems? A study on operating room efficiency","volume":"60","author":"Paramasivam Meenakshi Sundaram","year":"2024","unstructured":"Paramasivam Meenakshi Sundaram PPeh DYYPoh JWDoes robotic spine surgery add value to surgical practice over navigation-based systems? A study on operating room efficiency. Medicina (Kaunas). 2024;60(12):2112. doi:10.3390\/medicina60122112"},{"key":"bib1","article-title":"Bertolotti syndrome","author":"Miller","unstructured":"Miller AEZhang A.Bertolotti syndrome. In: StatPearls. StatPearls Publishing; 2024. Accessed March 2024. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK585032\/"},{"issue":"2","key":"bib2","series-title":"Orthop Rev (Pavia)","first-page":"24980","article-title":"A comprehensive update of the treatment and management of Bertolotti\u2019s syndrome: a best practices review","volume":"13","author":"Crane","year":"2021","unstructured":"Crane JCragon RO\u2019Neill JA comprehensive update of the treatment and management of Bertolotti\u2019s syndrome: a best practices review. 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Int J Spine Surg. 2015;9:42. doi:10.14444\/2042"},{"issue":"6","key":"bib5","series-title":"Pain Physician","first-page":"E923","article-title":"Decompressive L5 transverse processectomy for Bertolotti\u2019s syndrome: a preliminary study","volume":"20","author":"Ju","year":"2017","unstructured":"Ju CIKim SWKim JGLee SMShin HLee HY.Decompressive L5 transverse processectomy for Bertolotti\u2019s syndrome: a preliminary study. Pain Physician. 2017;20(6):E923-E932."},{"issue":"2","key":"bib6","series-title":"Arch Orthop Trauma Surg","first-page":"82","article-title":"Surgical treatment of Bertolotti\u2019s syndrome. Follow-up of 16 patients","volume":"112","author":"Santavirta","year":"1993","unstructured":"Santavirta STallroth KYlinen PSuoranta H.Surgical treatment of Bertolotti\u2019s syndrome. Follow-up of 16 patients. Arch Orthop Trauma Surg. 1993;112(2):82-87. doi:10.1007\/BF00420261"},{"issue":"9","key":"bib7","series-title":"J Gen Intern Med","first-page":"606","article-title":"The PHQ-9: validity of a brief depression severity measure","volume":"16","author":"Kroenke","year":"2001","unstructured":"Kroenke KSpitzer RLWilliams JB.The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-613. doi:10.1046\/j.1525-1497.2001.016009606.x"},{"issue":"1","key":"bib8","series-title":"Asian Spine J","first-page":"149","article-title":"Pelvic incidence as a determinant for chronic low back pain: few comments","volume":"9","author":"Ghobadifar","year":"2015","unstructured":"Ghobadifar MA.Pelvic incidence as a determinant for chronic low back pain: few comments. Asian Spine J. 2015;9(1):149-150. doi:10.4184\/asj.2015.9.1.149"},{"issue":"4","key":"bib9","series-title":"Control Clin Trials","first-page":"407","article-title":"Measurement of health status. Ascertaining the minimal clinically important difference","volume":"10","author":"Jaeschke","year":"1989","unstructured":"Jaeschke RSinger JGuyatt GH.Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials. 1989;10(4):407-415. doi:10.1016\/0197-2456(89)90005-6"},{"issue":"10","key":"bib10","series-title":"Clin Orthop Relat Res","first-page":"2027","article-title":"What are the MCIDs for PROMIS, NDI, and ODI instruments among patients with spinal conditions?","volume":"476","author":"Hung","year":"2018","unstructured":"Hung MSaltzman CLKendall RWhat are the MCIDs for PROMIS, NDI, and ODI instruments among patients with spinal conditions? Clin Orthop Relat Res. 2018;476(10):2027-2036. doi:10.1097\/CORR.0000000000000419"},{"key":"bib11","series-title":"J Clin Epidemiol","first-page":"200","article-title":"Effective dose 50 method as the minimal clinically important difference: evidence from depression trials","volume":"137","author":"Bauer-Staeb","year":"2021","unstructured":"Bauer-Staeb CKounali DZWelton NJEffective dose 50 method as the minimal clinically important difference: evidence from depression trials. J Clin Epidemiol. 2021;137:200-208. doi:10.1016\/j.jclinepi.2021.04.002"},{"issue":"3","key":"bib12","series-title":"Neurosurg Clin N Am","first-page":"323","article-title":"Spinopelvic parameters: lumbar lordosis, pelvic incidence, pelvic tilt, and sacral slope: What does a spine surgeon need to know to plan a lumbar deformity correction?","volume":"29","author":"Celestre","year":"2018","unstructured":"Celestre PCDimar JR II, Glassman SD.Spinopelvic parameters: lumbar lordosis, pelvic incidence, pelvic tilt, and sacral slope: What does a spine surgeon need to know to plan a lumbar deformity correction? Neurosurg Clin N Am. 2018;29(3):323-329. doi:10.1016\/j.nec.2018.03.003"},{"issue":"5","key":"bib13","series-title":"J Neurosurg Spine","first-page":"753","article-title":"Minimally invasive versus open lumbar spinal fusion: a matched study investigating patient-reported and surgical outcomes","volume":"36","author":"Mooney","year":"2021","unstructured":"Mooney JMichalopoulos GDAlvi MAMinimally invasive versus open lumbar spinal fusion: a matched study investigating patient-reported and surgical outcomes. J Neurosurg Spine. 2021;36(5):753-766. doi:10.3171\/2021.10.SPINE211128"},{"issue":"suppl 5","key":"bib14","series-title":"Eur Spine J","first-page":"564","article-title":"Pelvic parameters: origin and significance","volume":"20","author":"Le Huec","year":"2011","unstructured":"Le Huec JCAunoble SPhilippe LNicolas P.Pelvic parameters: origin and significance. 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A study on operating room efficiency. 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