Radiographic diagnosis of Limbus vertebra on a lateral cephalometric film: report of a case

Beyond the Bony Fragment: A Review of Limbus Vertebra

Vertebral limbus is a condition characterized by the intraspongious herniation of a portion of the nucleus pulposus. It is often asymptomatic, but it can sometimes cause nonspecific symptoms such as local pain and muscle spasm, or, in rare cases, radiculopathies, which is why it can be confused with vertebral fractures, spondyloarthropathies, infectious or tumoral processes. Early recognition of this pathology is preferable for a correct diagnosis and adequate treatment, the latter ranging from conservative approaches (such as personalized exercise programs and physical therapy) to surgical interventions reserved for severe cases with nerve compression.

Clinical effects of unilateral biportal endoscopic decompression for lumbar posterior apophyseal ring separation

Objective

The purpose of the study was to investigate the feasibility and effects of unilateral biportal endoscopic decompression for lumbar posterior apophyseal ring separation (PARS).

Methods

Patients with lumbar PARS who received unilateral biportal endoscopic decompression from June 2020 to September 2021 were analyzed, including 11 females and 15 males. The clinical symptoms were consistent with the imaging findings. Operation time, length of postoperative hospital stay and complications were recorded, and the clinical efficacy was evaluated by Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and modified Macnab scale at preoperative, postoperative 1, 3, 6 months and the last follow-up.

Results

Preoperative VAS scores of low back pain were (5.04 ± 1.37) and respectively decreased to (2.81 ± 0.75), (2.35 ± 0.98), (1.65 ± 0.69) and (1.15 ± 0.68) at postoperative 1, 3, 6 months and at the last follow-up, and the difference was statistically significant (F = 127.317, P = 0.000). Preoperative VAS scores of lower limb pain were (6.92 ± 1.38) and respectively decreased to (2.88 ± 1.07), (2.54 ± 1.03), (1.81 ± 0.80) and (1.00 ± 0.69) at postoperative 1, 3, 6 months and at the last follow-up, and the difference was statistically significant (F = 285.289, P = 0.000). Preoperative ODI scores were (60.47 ± 8.89) and respectively decreased to (34.72 ± 4.13), (25.80 ± 3.65), (17.71 ± 3.41) and (5.65 ± 2.22) at postoperative 1, 3, 6 months and at the last follow-up, and the difference was statistically significant (F = 725.255, P = 0.000). According to the modified Macnab criteria, the final outcome was excellent in 22 cases, good in 3 cases, fair in 1 cases. 26 patients could return to work or normal activities within 3 weeks.

Conclusions

Unilateral biportal endoscopic decompression has the advantages of clear and wide field of vision, large operating space, relatively simple need of surgical instrument and convenient and flexible operation procedure. It can achieve excellent clinical results with favorable efficacy and safety and may become a new minimally invasive endoscopic treatment for lumbar PARS.

Physiologic and Pathologic Calcifications of Head and Neck Significant to the Dentist

This article aims to help the practitioner identify structures found in routine three-dimensional imaging studies of the head and neck region and understand their significance and possible need for intervention. The prevalence of advanced imaging in dental practice, especially cone beam computed tomography, highlights the need to recognize and identify various high-density structures that are, in fact, soft tissue calcifications or alterations of normal bony anatomy. The wide range of these findings includes both benign and malignant pathologic entities as well as age-related calcifications and remodeling of normal anatomic structures and dystrophic calcifications.

Limbus Vertebrae as Incidental Finding in a Patient With Acute Lower Back Pain

Limbus vertebra (LV) represents a marginal interosseous herniation of the nucleus pulposus, usually in the midlumbar region. It is generally diagnosed as an incidental radiological finding during investigation of a case presenting low back pain or lumbar radiculopathy symptomatology. In this article, we report a case of a 37-year-old male patient complaining of acute low back pain. Imaging revealed a bone defect on the anterosuperior edge of L3 vertebra, finding that was attributed to LV. A comprehensive literature review was conducted regarding LV that should be included in the differential diagnosis of imaging findings of vertebral end defects.

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

PURPOSE

Lumbar posterior ring apophysis fracture (PRAF) is an uncommon disorder frequently accompanied by lumbar disc herniation (LDH). Over the years, there have constantly been published studies concerning this disorder. Due to its rarity, there is lack of an agreed treatment strategy, and lots of different opinions exist, including the choice of decompressive modalities, whether removal of apophyseal fragments or/and disc material, and the necessity of additional spinal fusion. The purpose of this review is to provide a collective opinion on the treatment of PRAF with LDH.

METHODS

A MEDLINE search in the English language literature was performed from 1980 to 2012. To be included in the study, it was strictly necessary for each clinical article to provide information about the description of apophyseal fracture such as location, treatment methods and clinical outcome. The studies were mainly analyzed for general features, the related classifications and treatments.

RESULTS

The literature searching yielded 19 articles reporting 366 patients experiencing 380 sites of fractures. All of them were case reports or case series. The classification systems of PRAF were various based on the morphology, mobilization, size or localization, and relationship between disc and fragment. The most used surgical options were posterior discectomy simultaneous excision of apophyseal fragments without spine fusion. Surgical treatment for PRAF with LDH had equally excellent clinical outcome compared with LDH alone.

CONCLUSIONS

The diverse features of apophyseal fracture lead to various modalities of classifications and operation options. Prior to operation, the surgeons should carefully make a plan to consider decompressive scope, removal of apophyseal fragment or/and disc and fusion or not. Because of methodological shortcomings in publications, it is not possible to definitively conclude what treatment modality is the best for the treatment of PRAF. More high-quality clinical studies are needed to draw more confirmable conclusions.

Possible brucellosis in an early hominin skeleton from sterkfontein, South Africa

We report on the paleopathological analysis of the partial skeleton of the late Pliocene hominin species Australopithecus africanus Stw 431 from Sterkfontein, South Africa. A previous study noted the presence of lesions on vertebral bodies diagnosed as spondylosis deformans due to trauma. Instead, we suggest that these lesions are pathological changes due to the initial phases of an infectious disease, brucellosis. The macroscopic, microscopic and radiological appearance of the lytic lesions of the lumbar vertebrae is consistent with brucellosis. The hypothesis of brucellosis (most often associated with the consumption of animal proteins) in a 2.4 to 2.8 million year old hominid has a host of important implications for human evolution. The consumption of meat has been regarded an important factor in supporting, directing or altering human evolution. Perhaps the earliest (up to 2.5 million years ago) paleontological evidence for meat eating consists of cut marks on animal remains and stone tools that could have made these marks. Now with the hypothesis of brucellosis in A. africanus, we may have evidence of occasional meat eating directly linked to a fossil hominin.