Lumbar surgery for 56 limbus fractures emphasizing noncalcified type III lesions

The clinical, radiologic, and surgical procedures performed for 56 out of 59 patients with Type I-IV fractures of the vertebral limbus were reviewed, stressing the diagnostic and operative management of noncalcified Type III (NC III) lesions. Forty-four calcified Type I-IV (CA I-IV) limbus fractures, interpreted as routine disc herniations on magnetic resonance imaging scans, were correctly identified as limbus fragments on computed tomographic and myelographic/computed tomographic studies, whereas 15 NC III lesions were mistaken for disc herniations alone on all three radiographic examinations. The preoperative recognition of the CA I-IV and NC III fracture types proved essential to the successful resection of five Type I, five Type II, 36 Type III, and ten Type IV fragments through extended laminotomies, hemilaminectomies, and laminectomies with the down biting curette, tamp, and mallet technique. In the absence of routine disc herniations, expanded standard dissectomies to the superior or inferior pedicular levels allowed for the identification and removal of NC III fractures.