Posterior limbus vertebral lesions causing lumbosacral radiculopathy and the cauda equina syndrome

Abstract

JapanThis report reviews our experience with spinal decompression for posterior limbus vertebral lesions or osteocartilaginous vertebral corner defects in the lumbar spine in 29 children and young adults. There were 19 male and 10 female patients with a mean age of 16.5 years (range, 9 to 24 years). Twenty-four patients were involved with various athletic activities.Clinical presentation included low back pain with a variable degree of radiculopathy in 25 patients and a cauda equina syndrome in four. The level of the affected spinal area was LJ-2 in one patient, L2-3 in one, L3-4 in seven, L4-5 in 17, and L5-S I in three. The preoperative imaging workup showed lateralised 'non-calcified' or 'calcified' limbus vertebral defects in 13 patients and centrally displaced lesions in 16 patients. All patients underwent posterior spinal decompression with a slightly extended laminotomy, except for three patients who had a subsequent posterolateral fusion. All of the patients consequently returned to practice their favourite preoperative sport and lifestyle, but five discontinued their previous sports. We suggest that patients with posterior limbus vertebral lesions require careful diagnosis and therapy that are different from those with an ordinary lumbar disc herniation.

A review of current treatment of lumbar posterior ring apophysis fracture with lumbar disc herniation

“…The most common clinical presentations of lumbar PRAF are generally similar to those observed in patients with LDH alone, including intractable low back pain and unilateral or bilateral radiculopathy [1,10,12,13,16,28]. If spinal stenosis exists, intermittent claudication is complained [10,23,35]. The presenting symptoms and physical examination findings include paravertebral muscle spasm and tenderness, the presence of motor deficits or/and sensory disturbances, and the loss of a deep tendon reflex.…”

“…Since the calcification and fusion process between ring apophysis and vertebral endplate may remain incomplete until the ages of 18-25, some studies thought the avulsion of this lesion was predominantly observed in the adolescents and young adults [4,23,26]. Takata et al [26] found that about half of the patients with PRAF were in their second decade of life, and most of the others were in their 20s.…”

“…All six patients with central or lateral small fragments had excellent results, whereas three of the six patients with large apophyseal fragments had poor results and must be informed of a greater chance to have chronic back pain. Similarly, Baba et al [23] suggested that patients with a small limbus bulge or non-calcified type III should be treated conservatively. Whereas, a large displaced fracture badly responded to conservative therapies.…”

“…Laminotomy or laminectomy was the mostly acceptable decompressive method used by most authors (Table 1). It was generally agreed in the literature that semi-laminotomy or laminectomy was indicated for posterolateral fracture, mostly the unilateral lesion (type III according to modified Takata classification and type II of Scarfo classification system) [10,20,23,24]. However, the limited intervention was proved to be inadequate to relieve the symptoms for the large and base-abroad fragment causing canal or foraminal stenosis.…”

“…However, the limited intervention was proved to be inadequate to relieve the symptoms for the large and base-abroad fragment causing canal or foraminal stenosis. Therefore, bilateral laminotomy or full laminectomy was required in cases of centrally located lesions (Types I, II and IV) suggested by many authors [6,10,20,[22][23][24][25]. For the fracture originated from the cephalad or caudad endplates, the extend resection of the superior or inferior adjacent lamina was necessary [10].…”