Lumbar posterior marginal intra-osseous cartilaginous node

Abstract

This report concerns 12 patients, eight young adults and four adolescents, presenting with lumbar or sciatic pain. This was associated with an unusual defect of the inferior and posterior edges of the vertebral bodies of L4 or L5, together with a small bony ridge protruding into the spinal canal. We found 11 similar cases in the literature, all involving adolescents except for one young adult. It has been considered to be the result of a fracture of the posterior ring apophysis in association with a herniated disc. In our cases, in the absence of any known previous trauma, the radiological features and surgical results and the similarity and frequent association with typical lesions of Scheuermann disease, all suggest a posterior marginal cartilaginous node. The inferior lumbar location and frequent association with herniated disc and sciatic nerve root compression in young patients are discussed.

The relationship of symptomatic thoracolumbar disc herniation and Scheuermann’s disease

“…Second, all patients suffered myelopathy or radiculopathy that warranted surgery, whereas neurological complications of SD; especially, in adults with mild kyphosis, were considered rare in the past [5,19]. Adequate evidence has shown that SD and its radiographic changes promote disc degeneration [6][7][8][9]20]. This was also demonstrated in our study in which SN, IE, PBA and WV were all found to enhance disc herniation in the TLDH group (Table 5).…”

“…It was frequently found to appear together with other signs of SD [8]. Previous studies reported PBA would occur at the lower lumbar spine at a low incidence and tend to promote symptomatic disc herniation [8,26,27]. The high incidence of PBA in symptomatic TLDH patients may be partly attributed to increased thoracolumbar kyphosis, as observed in this series, which could produce increased stretching stress on the posterior annulus of the discs.…”

“…PBA was considered an avulsion of the posterior ring apophysis due to the lack of fusion between the separated bony mass and the vertebral body [8]. It was frequently found to appear together with other signs of SD [8].…”

“…PBA was considered an avulsion of the posterior ring apophysis due to the lack of fusion between the separated bony mass and the vertebral body [8]. It was frequently found to appear together with other signs of SD [8]. Previous studies reported PBA would occur at the lower lumbar spine at a low incidence and tend to promote symptomatic disc herniation [8,26,27].…”

“…Interestingly, these changes were all related to another spinal disorder: Scheuermann's disease (SD) [5][6][7][8][9][10][11][12]. SD was initially named after Scheuermann's first description of a structural thoracic kyphosis with more than 3 wedged vertebrae that mainly affected adolescents [5], but it was subsequently recognized that other than Scheuermann's kyphosis, the pathological changes of SD involved disc lesions characterized by the above features, most commonly at the lumbar and thoracolumbar regions [6][7][8][9][10]. Moreover, there was a portion of SD patients who manifested disc lesions and only one or two wedged vertebrae but did not have significant Scheuermann's kyphosis.…”