VCOM Louisiana Research Day Program

Clinical & Case Studies

Natalie M. Regian, BS; Jeffrey R. Counts, DO; Randolph S. Devereaux, PhD Edward Via College of Osteopathic Medicine-Louisiana; Northeast Louisiana Orthopedic and Sports Medicine Clinic 30 A STUDENT’S OSTEOPATHIC APPROACH TO SACRAL PAIN IN THE POSTPARTUM, BERTOLOTTI’S PATIENT

Although Bertolotti’s deformity is a relatively common anomaly found within the orthopedic patient population, an incidence estimated to be about 18.5% in people less than 30 years of age, 1 no reporting has been done on how this hypertrophic transverse process affects the postpartum female. Documentation regarding the treatment of resulting symptoms with osteopathic manual manipulation or manipulative therapy (OMM or OMT) has yet to be shared. The patient discussed in this article not only received such osteopathic treatment for her symptoms, but the treatment has been entirely performed by a 3 rd year medical student. This case report will demonstrate the role of OMM/OMT in the conservative treatment and definitive diagnosis of Bertolotti’s syndrome in a patient with a radiographically confirmed deformity and clinically pertinent symptomology. This patient was referred to a 3 rd year osteopathic medical student for manipulative treatment after primarily presenting to an osteopathic orthopedic surgeon for evaluation of left-sided buttock and sacral pain. The patient is a 27-year-old primiparous female who was about 15-months postpartum when she underwent her first OMT session, but she has been experiencing a variety of associated symptoms since she was only about 6 weeks pregnant.

Clinical examination of the lumbar spine did not indicate an urgent or surgical pathological process and x-rays of the lumbar spine showed no remarkable findings, but an MRI of the lumbar spine identified the pseudoarthrosis of a hypertrophic left transverse process of L5 with the sacral ala, consistent with the description of Bertolotti’s deformity. 3 Following the completion and failure of conservative treatments including chiropractic care, Epsom salt baths, oral cyclobenzaprine, physical therapy, and pelvic floor therapy, the OMT was recommended. Six total OMT sessions were performed with minimal improvement in symptomology. Following these, the patient was offered additional conservative care from a manipulation-focused chiropractor or fluoroscopy-guided injections with an experienced anesthesiologist, as recommended as second-line in allopathic medicine. 2 She chose to proceed with the next caliber of care and was referred for injectional therapy, from which her results are still pending at the time of manuscript completion. The involved patient provided written informed consent to the use of her case for educational and literary purposes prior to the documentation of this article. Despite advancing the patient’s care plan to the use of invasive measures, the osteopathic treatments were effective in offering her a

worthwhile treatment beforehand. Resolution of her somatic dysfunctions and treatment focused on her anatomical deformity at L5 improved the patient’s outlook on her overall treatment plan and provided her with conservative evidence based treatment methods along the way.

43 2023 Via Research Recognition Day