Clinical Presentation Of Lumbar Disc Herniation: We Must Keep Also Limbus Fracture In Mind As A Cause

Abstract

A 49-year-old woman presented to Neurosurgery Clinic with a 4-month history of low-back pain radiating to her right leg. Patient's previous medical history was insignificant. There was no history of trauma. Neurological examination revealed a hypoactive Achilles reflex and a positive straight leg-raising test on the right side. Lumbosacral magnetic resonance imaging revealed that the L5-S1 intervertebral disc was herniated into the right L5-S1 foramen. The signal characteristics and the appearance of the lesion were atypical for a herniated disc. Computed tomography scanning showed a posterolateral rim fracture of the L5 inferior vertebral end-plate. The patient underwent surgery that involved wide L5 hemilaminectomy, removal of the fractured limbus, and L5-S1 discectomy. Limbus fractures are less frequent in adults, and they tend to be misdiagnosed. Plain radiography and MRI are often inconclusive and CT is essential for the true diagnosis. Our case is a good example of Type III.