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Year : 2006  |  Volume : 16  |  Issue : 4  |  Page : 997-999
Limbus vertebra


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How to cite this article:
Phatak SV, Kolwadkar PK. Limbus vertebra. Indian J Radiol Imaging 2006;16:997-9

How to cite this URL:
Phatak SV, Kolwadkar PK. Limbus vertebra. Indian J Radiol Imaging [serial online] 2006 [cited 2019 Aug 24];16:997-9. Available from: http://www.ijri.org/text.asp?2006/16/4/997/32415
Sir,

Anterior intraosseous herniation of the nucleus pulpous producing a limbus vertebra was first described by Schmorl in 1927 and later in detail by Neidner.Despite the long interval since description of the abnormality is often misdiagnosed as fracture. This misinterpretation can cause a great deal of concern for patient and the treating practitioner. The origin is due to trauma but most often it is not diagnosed until the patient is well into adulthood. Most investigators accept Schmorl's view that the limbus vertebra result from intrabody herniation of disc material.Schmorl 's node is a more central herniation into the vertebral into the vertebral endplate,where as limbus vertebra is caused by a marginal herniation.The anterior herniation of nucleus pulposus may cause a separation of a triangular smooth bony fragment which apparently represents a ring apophysis.This apophysis then remains separate from vertebral body. The anterosuperior margin of the vertebral body is more frequently affected because of the difference in size of the adjacent vertebral bodies the upper one being smaller. Because of this disparity, during flexion the anterior portion of the disc would be forced into the superior end plate of larger inferior vertebra [1] A limbus vertebra is a bony structure consisting of the anterosuperior border of vertebral body. They are almost always seen in lumbar spine and only rarely multiple. There are two theories regarding its origin first a developmental anomaly representing a failure of the anterosuperior portion of vertebral ring apophysis to normally fuse with vertebral body.and second is a transosseous extrusion of disc material between the anterior extent of ring apophysis and vertebral body thereby presenting subsequent fusion. It is believed that in many or most cases the later mechanism is responsible. Sharpeys fibres in the periphery of the annulus fibrosus insert into the ring apophysis of adjacent vertebrae. During childhood this union is stronger than vertebral body itself. Therefore during episodes of trauma the vertebral body may fracture and / or disc material may preferentially extrude through [transosseous] the anterosuperior vertebral body; the annulus fibrosus in such cases remains intact. In chronic cases conventional radiography shows a well corticated triangle of bone adjacent to and separated from the parent vertebral body by a radiolucent line. There may be marginal bony sclerosis on both sides of lucent line. Thin section CT with Sagittal reconstruction will show similar findings. Conventional contrast discography will demonstrate tracking of contrast injected into the central disc from the nucleus pulposus into oblique space between the triangular bone fragment and the vertebral body. Sagittal MR will show continuity of the intervertebral disc with oblique vertebral defect in the anterosuperior border of vertebral body, extruded disc material may lie beneath the anterior longitudinal ligament. There may be marginal mixed signal changes surrounding oblique vertebral defect compatible with edema, fatty marrow alteration and /or bony sclerosis. Most limbus vertebrae are usually associated with disc bulging and degeneration. [2] Schmorl's nodes are herniation of nucleus pulposus material into the trabecular bone of the vertebral end plates.Some investigators have suggested that these herniations develop from congenitally weak points in cartilagenous disc plates left by attrition of blood vessels and small defects from notochord remnants.Schmorl,s nodes may occur spontaneously or may result from stress from axial loading ,especially in young athletes or in cases of trauma.Hansson and Ross reported two different forms of Schmorl's nodes.Irregularely shaped Schmorls nodes in various locations occurred only in vertebrae with low mineral content and relatively low compressive strength .Regularly shaped Schmorl's nodes were not related to general weakness of the vertebral body.[3] Any pathologic condition that weakens the osseous structure of vertebral body is a predisposing factor for intravertebral cartilagenous herniation i.e. primary and secondary hyperparathyroidism,osteoporosis and neoplastic disease [4]

 
   References Top

1.Deborah Pate, DC, DACBR Limbus Vertebra Dynamic Chiropractic May 31,1999,Vol 17,Issue 12 www.chiroweb.com/archives/17/12/10.html  Back to cited text no. 1    
2.Limbus vertebra Neurodiagnostic imaging Pattern Analysis and Differential Diagnosis J.Randy Jinkins ,Claudia da costa Leite Lippincott-Raven1998:1006-1007  Back to cited text no. 2    
3.Axel Stabler,Marjanne Belan,Max Weiss,Christian Gartner,Joachim Brossman,Maximilan F.Reiser MR Imaging of enhancing intraosseous disc herniations(Schmorl's nodes) AJR 1997;168:133-138   Back to cited text no. 3    
4.Resnik D,Niwayama G.Intravertebral disc herniation:Cartilagenous(Schmorl's nodes)Radiology 1978;126:57-65  Back to cited text no. 4    

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Correspondence Address:
Suresh V Phatak
101,Vijay Arcade----16, North ambazari Road, Shankar nagar chowk, Nagpur 440012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.32415

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