The patient complained of low back pain that radiated to the left leg, of more than 1 month duration. Physical examination was difficult due to poor patient cooperation. On plain lumbar spine films a small bone defect is seen on the posterior lower corner of the fifth lumbar vertebrae. CT examination followed.
The patient complained of low back pain that radiated to the left leg, of more than 1 month duration. Physical examination was difficult due to poor patient cooperation. On plain lumbar spine films a small bone defect is seen on the posterior lower corner of the fifth lumbar vertebrae. On lumbar CT scans, a bone fragment is seen on the posterior left border of the fifth lumbar vertebrae.
A limbus vertebrae is a corticated bone density adjacent to the vertebral body. It can be either anterior or posterior, and consequently, of variable symptomatology. If the defect is anterior, minimal sypmtoms can be manifested, such as stiffness, or loss of the physiologic lordosis. On the contrary, if the defect is posterior, then symptoms mimicking nerve root compression will be manifested. Anterior limbus vertebrae is far mor common than posterior limbus vertebrae. The lesion is more frequent in the lumbar spine. Since it is a condition associated with development, it will be seen in adolescence. Four types of limbus vertera have been described, type I consisting on the avulsion of the posterior cortical rim; type II composed of central cortical and cancellous bone lesions; type III being more lateralized chip lesions; and type IV being lesions which span the entire length and breadth of the posterior vertebal margin, between the end plates. On plain films, a bone defect with or without a bony density in front of the defect can be seen. If there is a previous history of trauma, this can be misinterpreted as a vertebral fracture. On CT scans, the defect is clearly shown, with the bony fragment in front of the defect, and in the case of posterior lesions, pressure over the nerve roots and/or the spinal theca can be seen.
posterior limbus vertebrae
Based on the provided lumbar spine X-ray and CT images, a small bony defect can be seen at the posterior inferior margin of the L5 vertebral body, along with a bony fragment at the posterior edge (separated from the main vertebral block). This radiographic characteristic indicates a separated fragment composed of both cortical and cancellous bone at the vertebral margin. The patient reports low back pain with radiating pain to the left lower limb, possibly related to irritation or compression of the nerve root or dural sac in that region.
This condition is a developmental anomaly of the vertebral ring apophysis, commonly observed in the lumbar spine. When the apophyseal ring separates from the vertebral body, imaging commonly reveals a “defect + separated bony fragment.” In the posterior margin, this can lead to nerve root compression manifesting as low back pain and sciatica.
If the patient has a history of trauma or intense physical activity, an avulsion fracture could occur at the posterior margin of the vertebral body, resulting in separation from the main vertebral block. Similar bony fragments may be seen on imaging. Usually, there is a significant trauma history, and the fracture surface may appear relatively recent or show signs of callus formation. If it is an old change, repeated recent trauma should be ruled out.
Schmorl’s nodes typically involve the intervertebral disc herniating into the vertebral endplate in a vertical direction and do not commonly present with a distinct bony fragment at the posterior margin. Therefore, in this case, a posterior limbus vertebra is more likely.
Taking the patient’s age (32 years), clinical symptoms (low back pain radiating to the left lower limb), and radiological findings (a defect and fragment at the posterior margin of the L5 vertebral body) into consideration, the most likely diagnosis is Posterior Limbus Vertebra (Type I), caused by separation of the ring apophysis at the posterior margin.
1. Conservative Treatment: In the absence of significant nerve root compression, conservative management and observation should be tried first. This may include standard analgesics (e.g., non-steroidal anti-inflammatory drugs), physical therapy (heat applications, ultrasound therapy), lumbar strengthening exercises, and posture correction.
2. Physical and Rehabilitation Training: After the pain subsides, it is suitable to gradually initiate nerve mobilization techniques and core strengthening exercises. For example:
• Gentle stretching of the lumbar and back muscles, and basic core tightening (e.g., supine abdominal bracing).
• Each session lasts about 10 minutes, 1–2 times a day, performed slowly, avoiding significant pain exacerbation.
• Progress to core stability training (e.g., plank, bird-dog exercises) alongside lower limb strength training (such as seated resistance exercises).
• Each session lasts 20–30 minutes, 3–4 times a week, gradually increasing duration and intensity as tolerated.
• Introduce functional exercises, such as partial weight-bearing squats or resistance band training for the lower limbs, to further enhance mechanical stability and coordination.
• Each session lasts 30–45 minutes, 3–4 times a week, focusing on proper form and avoiding excessive spinal loading.
3. Surgical Treatment: If significant symptoms persist despite conservative management, or if nerve root compression worsens (e.g., pronounced sciatica, progressive weakness or sensory deficits), surgical decompression or removal of the posterior fragment may be considered to alleviate nerve compression. However, surgical indications must be carefully evaluated by a specialist in spinal surgery.
4. Safety and Individualized Approach: All training should take into account the patient’s pain tolerance, spinal stability, and any underlying comorbidities. If necessary, exercises should be performed under the guidance of a professional rehabilitation therapist or orthopedic physician, ensuring a gradual and safe progression.
Disclaimer: This report is based on the provided medical history and imaging data for reference only. It does not replace in-person consultation or the advice of a qualified medical professional. Specific treatment plans should always be determined by a specialist, considering the patient’s individual circumstances.
posterior limbus vertebrae
