Limbus Vertebra and Chronic Low Back Pain

Case Report

J Fam Med. 2016; 3(1): 1048.

Limbus Vertebra and Chronic Low Back Pain

Acosta V¹, Pariente E²*, Lara M¹, Pini SF¹ and Rueda-Gotor J³

¹University Hospital Marqués de Valdecilla, Santander, Spain

²Family Medicine Department, Primary Care Centre “Camargo-Interior”, Muriedas, Cantabria, Spain

³Musculoskeletal Unit, University Hospital Marqués de Valdecilla (Santander), Spain

*Corresponding author: Emilio Pariente, Primary Care Center “Camargo-Interior”, 39600 Muriedas (Camargo) Cantabria, Spain

Received: December 13, 2015; Accepted: January 12, 2016; Published: January 14, 2016


Limbus vertebra is defined as the presence of an ossicle or an adjacent bone affecting the margin angle of the vertebral bodies. The characteristic appearance on plain films is a detached fragment with triangular morphology and sclerotic margins. It represents a marginal herniation of the nucleus pulposus during childhood or adolescence through the vertebral end-plate and beneath the apophyseal ring.

Usually it is considered an incidental finding and an asymptomatic entity. However, several studies have suggested a significant relationship between the limbus vertebra and the low back pain (LBP), possibly due to an underlying intervertebral disc degeneration (IDD).

In order to contribute to the debate, we present the case of an adult male who has a double limbus vertebra and suffers from chronic LBP.

Keywords: Limbus vertebra; Radiological abnormalities; Low back pain


LBP: Low Back Pain; NSAIDs: Nonsteroidal Anti-Inflammatory Drugs; CT: Computerized Tomography; MRI: Magnetic Resonance Imaging; ALV: Anterior Limbus Vertebra; IDD: Intervertebral Disc Degeneration

Case Presentation

Male, aged 53 years. He worked as a truck driver, with activities that involved lifting heavy loads. He lived in a cattle area of Argentina during eight years. Chronic psoriasis on elbows and knees and an acute coronary syndrome in 2008 are the most relevant personal antecedents. He suffers from a chronic LBP that began at the age of 30 and the symptoms are almost daily, with few variations along these years. Occasionally the pain radiates to the back of the left thigh, without paresthesias. He denies the existence of “red flags” symptoms including fever, constitutional syndrome or inflammatory pain. The pain improves with rest and nonsteroidal anti-inflammatory drugs, but does not disappear completely. He describes morning stiffness that lasts about an hour. In the physical examination, neither arthritis nor enthesitis were noted and the muscular strength was normal, as well as the Achilles and patellar tendon reflexes. Radiculopathy and sacroiliac maneuvers were negative. Lumbar spine radiography showed rectification of the lumbar lordosis, avulsion of the anterior superior angle of L3 and L4 vertebral bodies, narrowing of the L2- L3 and L3-L4 spaces, posterior osteophytes and inter-apophyseal osteoarthritis (Figure 1). The patient underwent a blood analysis -including Rose Bengal test for brucellosis and acute phase reactants like erythrocyte sedimentation rate and C-reactive protein- and all results turned out normal or negative. Computerized tomography (CT) and magnetic resonance imaging (MRI) of the lumbar spine showed vertebral epiphysitis in L3 and L4, degenerative changes in disc spaces L2-L3 and L3-L4, a bulging disc between L2-L3, a central herniation in L3-L4 and a left side herniation in L5-S1, none of them with apparent compressional effect. MRI of sacroiliac joints did not show relevant abnormalities.

Citation:Acosta V, Pariente E, Lara M, Pini SF and Rueda-Gotor J. Limbus Vertebra and Chronic Low Back Pain. J Fam Med. 2016; 3(1): 1048. ISSN : 2380-0658