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Old 09-14-2007, 09:47 AM   #1
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ihavtwins HB User
Unhappy Transitional Vertebra/ Having facet fusion

Hi, I have had lower back pain for almost 2 years now. All my tests show minor this and minor that, but nothing real concrete. I have had mri, xray, discogram, bone scan, and several types of cortizone injections. My doctor has concluded that my transitional vertebra has caused damage to the level above it and is going to try to fuse the facet joints that are full of arthritis and bone spurs.

I am only 36, and am very concerned. What will this surgery be like? Will a transitional vertebra cause more problems down the road? I would love to talk to some people who have a transitional and what they have been through.

I have felt so alone the last 2 years, the doctors never believing I am in the pain that I am. It has got to the point of limping on the right side of my body. I have been through 2 years of agony, trying to find out whats wrong with me. I feel like the transitional vertebra might be my answer all along.

I would love to get some more info here. Thanks for listening!
My surgery is set for Sept 27th.

Jen

 
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Old 09-14-2007, 11:19 AM   #2
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Re: Transitional Vertebra/ Having facet fusion

Jen, my first fusion in 1982 was for a transitional vertebrae. I had it fused and lived a pain free life until 2004. Then I hurt the level above it and required a fusion in 2007 and now I am facing a 3rd fusion on the one above it.

I am telling you not to scare you but let you know once you have a fusion you risk having the ones above them going out and needing to be fused. As you can see between my first and second fusion there was a huge time span and between the 2nd fusion and 3rd fusion looks like it will be one year.

Do I regret going thru the fusions? Absolutely not!! After each one I felt better; however, between my latest fusion and the upcoming one is a bit shorter than I would like. I suspect that the newest level should have been fused last year.

I hope I have not scared you and if you have any specific questions ask away.

 
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Old 09-14-2007, 11:34 AM   #3
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Re: Transitional Vertebra/ Having facet fusion

Thank you for your quick reply! I have a ton of questions for you. The doc says he is only fusing the facet joints. Did you have your actual vertebra fused? I have a lumbarized S1. Is this what you have also? Have you heard of Bertolotti's syndrome? Did you have trouble getting your doc to do the surgeries? My doc was terrible about trying absolutely everything before doing surgery and saying there really wasnt a whole lot on the tests but a transitional vertebra. He said he was going by my pain, not the tests. I am in lots of pain and nothing I have tried in 2 years has helped.

I am hopeful that you had such a success with your first surgery! However, he is going very minimal and wont be fusing my transitional vertebra, only the facets I think, and I have no idea what the recovery time on this is or anything. I will find out more on pre op on the 20th.

Thank you so much for your reply. I appreciate it!
Jen

Last edited by ihavtwins; 09-14-2007 at 11:41 AM. Reason: spelling

 
Old 09-14-2007, 11:52 AM   #4
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Re: Transitional Vertebra/ Having facet fusion

I had the entire vertebrae fused and have not heard of Bertolotti's syndrome. I was 17 at the time and there was no question in regards to needing surgery. I grew up with pain off and on and my parents basically swept it under the carpet. Until one day, I got up and went to put my legs on the floor and landed square on my bottom. I could not feel my legs. I had surgery within 2 days. Boy did my mom feel bad!!

Have you had a second opinion?? I would strongly recommend it just for peace of mind.

 
Old 09-14-2007, 09:12 PM   #5
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Re: Transitional Vertebra/ Having facet fusion

[QUOTE=ihavtwins;3208678]Thank you for your quick reply! I have a ton of questions for you. The doc says he is only fusing the facet joints. Did you have your actual vertebra fused? I have a lumbarized S1. Is this what you have also? Have you heard of Bertolotti's syndrome? Did you have trouble getting your doc to do the surgeries? My doc was terrible about trying absolutely everything before doing surgery and saying there really wasnt a whole lot on the tests but a transitional vertebra. He said he was going by my pain, not the tests. I am in lots of pain and nothing I have tried in 2 years has helped.

I am hopeful that you had such a success with your first surgery! However, he is going very minimal and wont be fusing my transitional vertebra, only the facets I think, and I have no idea what the recovery time on this is or anything. I will find out more on pre op on the 20th.

Thank you so much for your reply. I appreciate it!
Jen[/QUOTE]

Jen, what did your MRI state exactly, if i can ask?
Love, Monkey

 
Old 09-14-2007, 09:40 PM   #6
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Re: Transitional Vertebra/ Having facet fusion

Jen, thank you thank you! I did a quick search and with your post found out this information because of the finding on my MRI report i may even print it out although i am worried about the dr. thinking i'm crazy on my first appt. what do you think? And pepper please any suggestions to this? Sorry so long love, Monkey


Transitional Vertebrae:

A transitional vertebrae is either a sacralized lumbar vertebrae or a lumbarized sacral vertebrae. In the present study, a transitional vertebrae is defined as a vertebrae that presents with a distinctive enlargement of the transverse processes with or without fusion of the processes to the sacrum. Vertebrae that were bilaterally sacralized or lumbarized were not considered a transitional vertebrae. The reported prevalence of transitional type of vertebrae at the lumbosacral junc- tion has varied from 0.6 to 25% of persons (10,11).

Sacralization, and the presence of lumbosacral transitional vertebrae are anomalies in which an increased incidence of backache have been established in some reports, while other studies have revealed no apparent association.

Those who report a correlation between transitional vertebrae and backache feel that the etiology of the production of pain is due to the alteration in the symmetrical supportive bony architecture of the spinal vertebral column. With an asymmetrical condition the center of spinal rotation moves from the midline and is located nearer to the side of sacral articulation/fusion. The facet articulations and related structures on the side with a free transverse process will move through a greater arc of motion and be subjected to a greater amount of torsional stresses. This greater degree of stress predisposes to facet degeneration, disc deterioration, and possible disc protrusions(10,11).

Tiley, in a study of 7,236 pre-employment radiographs demonstrated 1,103 (14%) with sacralization of the fifth lumbar vertebrae. He noted a significant relationship between unilateral sacralization and variation in the articulating mechanism of the facets. Individuals with sacralization showed a greater occurrence of low back pain and more time lost from work than those workers without the condition(12).

Paillas, Winniger and Louis studies 1,000 individuals with lumbar pain and sciatica and 500 with proven disc protrusions, and they demonstrated a strong association between transitional vertebrae and back pain. The occurrence of pain and sciatica was nearly twice that of patients without transitional vertebrae (15.5% vs. 7.78%). They also demonstrated that the average age of patients with lumbar pain and congenital anomalies was 10 years younger than for individuals with a normal lumbar spine(13).

Hodges and Peck studies 447 individuals with back pain and 538 controls (as was previously mentioned). With respect to transitional vertebrae, the study showed a significant association with back pain(6).

Transitional vertebrae have been linked by some doctors to a clinical entity consisting of low back pain, with or with-out sciatica, which is associated with a disc herniation at the vertebral level craniad to the sacral articulation (Bertolotti's syndrome). This syndrome may be another cause of pain associated with the condition of a transitional vertebrae. Keim, has presented a series of 12 patients with this clinical presentation(14).

There are also several studies that did not establish any association between transitional vertebrae and the presence of back pain. It is postulated that a transitional vertebrae, by virtue of its enlarged process, is more stable and better protected from stresses, than a "free" vertebrae." The large transverse process is believed to add to the rotational stability of the vertebral column. LaRocca and Macnab, in their study of 150 men with back pain vs. a control group of 150 men, did not demonstrate a difference due to the presence of a transitional vertebrae(4). These findings were duplicated in the reports of Fischer, Friedman, and Van Demark(3), as well as in the study of Splithoff(5).

In the present study, no correlation was established for the occurrence of a transitional vertebrae and the presence of back pain. Also, just as for facet asymmetry, the rate of agreement between the three physicians in diagnosing transitional vertebrae was poor.

Conclusion

In considering the presence of facet asymmetry, spina bifida occulta and transitional vertebrae in relation to low backache, in this study, only spina bifida occulta showed any statistical association with low back pain. Even for this anomaly, the statistical correlation was slight. This was also the only condition in which the doctors showed a similar rate of diagnosis (agreement in the diagnosis of the condition). In analyzing various combinations of the anomalies and the predisposition to back pain, the presence of all three anomalies showed some association, however, the agreement of the physicians in delineating such individuals was quite poor. As stated in this report, a review of the medical literature reveals considerable variances in relating congenital anomalies of the lumbar spine to backache/pain. As demonstrated in this study, this could be due to the considerable rate of difference among observers in diagnosing an anomaly as present. If one were to attempt to remedy this problem, perhaps an application of more stringent criteria in defining these conditions could help to provide more answers as the etiology of low back pain.

 
Old 09-14-2007, 10:10 PM   #7
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Re: Transitional Vertebra/ Having facet fusion

pepper, i know you are not a dr. like you said and you have to be careful whats posted but what is your thought on this? Could this be why i have less hip rotation ect.?
I'm asking you because you replied to what i posted about my MRI findings!



Bertolotti's syndrome is a form of lumbago in the lumbosacral transitional vertebrae. The syndrome is not usually treated, as not much is known yet about these spinal segments. It is named for Mario Bertolotti, an Italian physician [1]

Bertolotti's syndrome is defined by a transitional 5th lumbar vertebra resulting in partial sacralization. Of importance is that this syndrome will result in a pain generating 4th lumbar disc resulting in a "sciatic" type of a pain correlating to the 5th lumbar nerve root. Usually the transitional vertebra will have a "spatulated" transverse process on one side resulting in articulation or partial articulation with the sacrum or at time the illium and in some cases with both. This results in limited / altered motion at the lumbo-sacral articulation. This loss of motion will then be compensated for at segments superior to the transitional vertebra resulting in accelerated degeneration and strain through the L4 disc level which can become symptomatic and inflame the adjacent L5 nerve root resulting in "sciatic" or radicular pain patterns. This is a congenital condition and is usually not symptomatic until one's later twenties or early thirties, yet there are cases found where Bertolotti's is symptomatic at a much earlier age.

 
Old 09-14-2007, 10:29 PM   #8
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Re: Transitional Vertebra/ Having facet fusion

pepper, i also found this..........
Bertolottiís syndrome is characterised by anomalous enlargement of the transverse process(es) of the most caudal lumbar vertebra which may articulate or fuse with the sacrum or ilium and cause isolated L4/5 disc disease.
Love, Monkey

 
Old 09-15-2007, 05:13 AM   #9
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Smile Re: Transitional Vertebra/ Having facet fusion

Monkey, thank you so much for your email. I am so tired of feeling alone in this. I would definately show your doctor the info on transitional vertebra, but not that long study because it was kind of negative at the end toward treating people with transitional vertebra. My doc was hesitant for surgery for me after almost 2 years of pain. It is not a usual reason to perform surgery but it can give them more reason to look and think about why the degeneration is happening.

It can absolutely make your hip sore. I went to PT for a while stretching out my hip, which made it tons better, and now my hip is fine. Do some stretching daily on that hip. I actually had hip xrays, it hurt that bad, but nothing showed.

My original xray only showed an osteophyte at L5. It was called minimal.

My MRI showed minimal disc bulging at L4-L5, mild bilateral facet joint hypertrophic change L4-L5 and L5-S1. Also mild bilateral neural foraminal encroachment. Mild lumbar spondylosis. Facet prominence at L5. There is a transitional S1 body which is partly lumbarized.

The words mild made me mad because i was in so much pain. Doctors would read these reports and not figure out why i am in so much pain.

Are you waiting to be diagnosed yourself? I would love to hear your story. I am just now getting some real help. I go for surgery on the 27th to fuse the arthritic joints. but i am worried because of reading about other people who have the transitional fused, i wonder if that is a better idea or not.

i read about transitional V and it is kinda like walking with one shoe on , it says. I am now limping on the right side due to the pain and misalignment of the transitional.

It took me almost 2 years to even find the word Bertolottis syndrome. I hope it has been helpful here. They have been trying to figure out my pain for a long time, and kept poking me with cortizone which doesnt help. I have been on pain meds for this whole time too.

If you have any other questions Monkey let me know, I would love to hear from you again!

Jen

Last edited by ihavtwins; 09-15-2007 at 05:24 AM. Reason: adding more info

 
Old 09-15-2007, 05:31 AM   #10
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Re: Transitional Vertebra/ Having facet fusion

Okay...I can think more clearly now that meds are helping with the pain. Sorry I have been out of it.

I don't know if this wil help you or not but in my case they said s1 vertebrae was laying directly on s2 vertebrae and they were moving splinter the bone and compressing the nerves every time I walked.

Having the full vertebrae fused was the best thing I could have had done at 18. It gave me 22 years of a pain free life. We just won't talk about the last 4!!

 
Old 09-15-2007, 05:41 AM   #11
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Re: Transitional Vertebra/ Having facet fusion

Monkey
I am unclear on what type of doc you are going to. is it neurosurgeon? I went to a neurologist and he was no help at all, told me to do some exercises.

I went the orthopedic route and they were not any help either.

The guy I am seeing now is at a place called the back center, and he is strictly a back surgeon. He is a teaching doctor, so he is more open to things like this. He is willing to use me as a teaching case, which is awesome because no one else would help me.

Hope that helps.
Jen

 
Old 09-15-2007, 05:44 AM   #12
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Re: Transitional Vertebra/ Having facet fusion

[QUOTE=123dietdrpepper;3209642]Okay...I can think more clearly now that meds are helping with the pain. Sorry I have been out of it.

I don't know if this wil help you or not but in my case they said s1 vertebrae was laying directly on s2 vertebrae and they were moving splinter the bone and compressing the nerves every time I walked.

Having the full vertebrae fused was the best thing I could have had done at 18. It gave me 22 years of a pain free life. We just won't talk about the last 4!! [/QUOTE]

How did they determine that this was happening while you were walking, a certain type of xray? I have done xrays straight and bent, but not anything that simulates walking. My biggest pain is after I have walked a distance or walked on a concrete floor, or even standing for longer than 15 minutes. Did you ever try Lyrica for pain? I just started on it yesterday. It helps a little. It is supposed to be for nerve pain.
Jen

 
Old 09-15-2007, 10:23 AM   #13
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Re: Transitional Vertebra/ Having facet fusion

Rhonda, so sorry you have been out of it but are you getting some relief? I have had a fairly good week, just didn't take no walks, didn't go to the store, did what i had to, so that i can stay somewhat comfortable. I have an appt. Monday for my ovaries, hopefully not bad, and then i should hear from the Neuros office!

Jen, this is neat, i have twins also! No you are not alone! My story is this: After a car accident a few years back, i started having mild back lower left pain wich would at times radiate into my hip area. I was referred to have an exray to make sure i didn't have arthritits because that would be bad, and it came back clear, so they set me on my way. But at the same time told me my hip doesn't rotate like it should when i bend(should have gave them a clue ) So i went about my business, worked ect. Then it got worse i was limping ect. So i switched dr.s and they sent my to the pain clinic, neurosurgeon(whom said i didn't need surgery) went to pt, and had a mri, bone scan, emg, all in the same time, with nothing showing. Again i went about my business. But this time at my job i was working seasonal at a greenhouse and i got so weak on my left side i couldn't even walk, pain ect. I also fell on the ice around that time, but didn't get any worse. Then this year i went to the greenhouse trying to give it another try(left early last year) and it happened again, but this time it was like my whole leg gave out on me and i fell again. So back to the dr.s and getting denied by offices another emg normal, hip exray normal, and recent MRI finds of this:

Transitional Element at Lumbosacral Junction is felt to Represent a Partially Sacralized L5 with a Broad Transverse Process on the left Forming Anomlous Artticulation with the upper sacrum.
Now since the fall four months ago i have yet to see a specialist other than an Ortho wich said nothing and sent me on my way. Since i fell i have had pain, numbness, weakness muscle spasms ect, and even went to the ER wich said it is a nerve and you need to see a Neurologist, and my dr. kept referring me to a Neurosurgeon. So this has gone on for at least two years with the worst being four months ago when i fell. Now the bad thing is that i went to PT for two and a half months with not much relief just made it easier to walk with a can ect. but then i stopped going and my Dr. agreed as then didn't even know what they were treating, and then now i have been compensating the other leg with the good one that one falls weak so i really have to watch my activities, or i can't walk at all. Please tell me there is hoope? I am so worried i am gonna have permanent damage by the time i get treatment. Same as you if i walk a distance or stand on concrete, i get really bad or if now if i stand to long ect. and in my opinion i shouldn't have been doing this type of work and now i may never be able to go back, but it probably didn't help. Jen, the Neurosurgeon wouldn't see me because he said there is no findings blah blah, and i have yet to see the Neurologists wich is next, and the spine center here in my area would't see me ithier. So if this Neurologists denies i am out of options, unless i guess well lose bladder control and then let me tell you. I am so arfaid i will be turned down again and i don't know what i have, and i'm not a dr. so i don't really technically know what my MRI means or any of this i just know what i'm reading, and it's not fair to me to have to live like this and at some point someone professionally needs to see and hear me out, and i don't when or who that is gonna be. Talk to you soon.
Love, Melissa

 
Old 09-15-2007, 11:45 AM   #14
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Re: Transitional Vertebra/ Having facet fusion

[QUOTE=monkey5;3209961]Rhonda, so sorry you have been out of it but are you getting some relief? [/QUOTE]

Monkey, I want you to know that my name is not Rhonda. Rhonda is someone else on the board that uses the username Dr. Pepper; I am 123DietDrPepper and known as Pepper. I know very confusing!!

Yes my meds are starting to give me some relief. Thank you for asking.

 
Old 09-15-2007, 12:29 PM   #15
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Re: Transitional Vertebra/ Having facet fusion

yeah I've gotten confused before and I've known diet for along time now lol

I am meds ofcourse here, but I remember mine saying I had that extra vertebrae but forget what its called. Anyway my mri had said somethng like attempted sacrialization. Anyway don't know if its the same or not. But had fusion six months ago.

 
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