RESUMO
La vertebra limbus es un hallazgo radiológico de prevalencia desconocida y significado incierto. Se trata de un defecto óseo que afecta al margen de los cuerpos vertebrados, con un fragmento desprendido de morfología triangular y bordes escleróticos. Se produce como consecuencia de una herniación intraósea del núcleo pulposo a través del anillo apofisario vertebral, antes de la fusión completa del cuerpo vertebral. En este artículo se describe tres casos clínicos de pacientes jóvenes (de 19, 20 y 22 años), reclusos en el Centro Penitenciario de Jóvenes (Barcelona, España), diagnosticados de lumbalgía mecánica crónica, y portadores de vértebras limbus lumbar. Nuestros hallazgos, y la revisión sistemática de la escasa literatura disponible, ponen en duda algunas convicciones actuales sobre la vértebra limbus.
The limbus vertebra is a radiological finding of unknown prevalence and uncertain significance. This is a bone defect which affects themargin of the vertebral bodies, with a triangular-shaped detached fragment and sclerotic margins. This occurs as a result of an intraosseus herniation of the nucleus pulposus through the vertebral apophyseal ring before the complete fusion of the vertebral body. In this paper we describe the clinical cases of three young patients(aged 19, 20 and 22), in mates of the Young Offenders Institute of Barcelona, Spain, who were diagnosed with chronic mechanical lowback pain and suffered from lumbar limbus vertebrae. Our findings, and the systematic review of the limited literature available, question some of the current beliefs about limbus vertebrae.
Assuntos
Dor Lombar , Coluna VertebralRESUMO
STUDY DESIGN: We studied retrospectively the limbus vertebra by computed tomography or magnetic resonance image. OBJECTIVES: To analyze the clinical and radiologic characteristics of the limbus vertebra and to distinguish it from a fracture, infection or tumor. SUMMARY OF LITERATURE REVIEW: The limbus vertebra is common. However, the clinical manifestations including the level, symptoms and radiologic characteristics of the limbus vertebra are not understood exactly in the literatures. MATERIALS AND METHODS: We presented 25 cases of the limbus vertebra that were confirmed by plain roentgenogram combined with computed tomography (CT) or magnetic resonance imaging (MRI). Of the 25 patients, 18 were males and 7 females. RESULTS: The levels of the limbus vertebra were L3 (2 cases), L4 (13 cases), and L5 (8 cases). There were two cases of 2 level involvement (L3/4 and L4/5). All cases showed the lower lumbar lesion and complained of the lower back pain. The accompanying diseases included 10 cases of herniated intervertebral discs, 2 cases of ankylosing spondylitis, 2 cases of spinal stenosis and one spondylolisthesis. Three patients were first diagnosed as tuberculous spondylitis and 2 patient as spine fracture on plain roentgenograms. But they can be confirmed by demonstrating the herniation of disc material between the anterosuperior bony fragment and the rest of the body in CT or MRI. CONCLUSIONS: The CT or MRI could be great diagnostic modalities. The pathogenesis is thought to be the herniation of disc material into the vertebral body such as Schmorl's node and disc degeneration. Most limbus vertebra was found at the lower lumbar region and accompanied with disc bulging and degeneration. The correlation between the limbus vertebra and lower back pain is not certain.