My name is John O'Donnell, and today I'll be discussing utilizing diagnostic injections and assessing surgical outcomes and treatment of Burt-Lowry syndrome. This presentation was made by Arthur Jenkins, Cameron Hargree, Richard Chung, myself, and Sarah Jenkins. We have no disclosures to mention. An LSTV is a congenital anomaly with incomplete sacralization or lumbarization of the thumbral sacral junction and occurs in about 15 to 35% of the population. But Lowry syndrome is the clinical presentation of pain of an LSTV. The symptoms include back, hip, groin, sacroiliac, or lower extremity pain. And this condition is poorly recognized and there are a few studies on diagnosis and treatments. Conservative management provides minimal or delayed relief with no cure. The approaches include PT, chiropractic, medication, and injections. Intervention with decompression or fusion has shown durable relief in recent studies. While injections for this condition have not shown durable relief, the use of injections can be beneficial for confirming diagnosis in spinal conditions. Other studies have referenced the use of injections into this targeted area, but there has been no large-scale, single-cohort analysis of Bert Lowry syndromes in the literature. We propose that the use of injections when targeted with patients of the above symptoms can predict favorable surgical response. We performed a retrospective cohort study from 2022 to 2023 of 100 consecutive patients presenting to the Jenkins neurospine and receiving dedicated injections from 2019 to 2023 into the LSTV anatomy. Patients were advised to maximize their symptoms with known triggers pre- and immediately post-injection to assess diagnostic value. Patients were provided a diagram demonstrating, depending on the patient's specific anatomy, the precise location and trajectory for the injection to maximize specifically the post-injection benefit. Patients were also instructed to record their VAS pain scores at several time points afterwards and relief duration. And here's an example of what the pain diagram would look like. So, of the 100 patients, 37 were men, 63 were women, the average age of 39. They received injections, 52 unilateral, 48 bilateral, at the LSTV transverse ally injections by 65 different practitioners. Prior to these injections, there was 102 injections without any significant relief. 95 of the 100 patients reported an improvement, averaging 83% of pain relief for five days, ranging with this pain relief, ranging from five minutes to three minutes. Of the five patients who did not receive greater than 50% improvement in symptoms, four out of the five received some relief and one did not continue with the practitioner. For almost all patients, these injections were the first injection to give them significant improvement regardless of the duration. And here's a graph representation of the duration of relief. 51 of the 95 patients who recorded relief opted in for surgery with seven decompressions and 44 fusions. 46 of the 51 patients ultimately experienced good relief, which is greater than 50% when fully healed from boatload of cesarean, suggesting a false positive rate of 9.8%. In this surgical cohort, there's no significant correlation between the duration of relief from the injection and the post-surgical pain relief. We do not have a clear false negative result due to our use of the positive response as a hard stop predictor for the benefit of surgery. Specificity is 56% due to a very low negative value of four out of 100. And without a false negative, sensitivity could not be calculated. And this is a graphical representation of the decrease in pain pre-op versus post-op greater than six months, and all of these values were significant. Many patients and practitioners deem injections unsuccessful or non-diagnostic when pain relief is short-lived with regards to boatloaded syndrome. Our data suggests that favorable response have a transient to number of sickle, intraverse injections can predict a durable response to surgery. Given this, operative selection of a section or fusion surgery should be based on the anatomic subtype according to our previous surgical outcome study. Given the high sensitivity of patients with transitional anatomy and symptoms suggested of boatloaded syndrome, as well as predictive value for surgical outcomes, patients with LSTV and suggestive symptoms should be considered for injections to diagnose boatloaded syndrome, which responds well to surgical management. All right, what conclusions can be made? Localized LSTV intraverse injections provide brief yet significant diagnostic relief of boatloaded syndrome. This can be confirmed with high surgical success rates via resection or fusion. The preliminary data suggests that boatloaded injections should be valued diagnostically based on the amount of relief during that duration rather than the duration. Our clinical success rate is similar to that of fusions for lumbar spondylolisthesis. We believe that we have achieved a high diagnosis rate due to our providing not only a location, but also a diagram for the performance of the injections in question, which given the often challenging angle of the LSTV anatomy likely benefited the performance edition. Our false negative rate may be related to several factors, including the presence of additional lumbar at logical levels and a wide variety in practitioners performing the injections. Further studies are ongoing to identify additional factors to improve both performance of injections and final outcomes after injections. Here's our references. Thank you.

Bertolotti syndrome

LSTV congenital anomaly

pain symptoms

surgical interventions

injections