Fraturas com arrancamento do anel apofisário ("limbus") póstero-superior da vértebra L5, associado com hérnia discal pré-marginal em atletas

Background: Posterior lumbar vertebral endplate fracture occurs with avulsion of the ring apophysis from the posterior vertebral body. Although this has been described in adolescents and young adults, proper diagnosis is often delayed or missed entirely. Surgery may be curative. Objective: To determine the common clinical features and treatment outcomes in youth and young adults with posterior lumbar vertebral endplate fractures. Design: Retrospective case series. Setting: Academic medical institution. Patients: Patients 10 to 25 years old from 2000 through 2012 with posterior vertebral endplate fracture diagnosis. Main Outcome Measurements: Demographic characteristics, diagnostic studies, interventions, and change in symptoms postoperatively.Results: A total of 16 patients had posterior vertebral endplate fractures (8 male patients; mean age, 15.2 years)-8.3% of 192 patients with inclusion age range undergoing spinal surgery for causes unrelated to trauma, scoliosis, or malignancy. The most common signs and symptoms were low back and radiating leg pain, positive straight leg raise, hamstring contracture, and abnormal gait. Cause was sports related for 12 patients (75%). Mean (range) time to diagnosis was 13.0 (3.0-63.0) months. Diagnosis was most commonly made with lumbar magnetic resonance imaging (n = 6). Most fractures occurred at L5 (n = 8, 50%) and L4 (n = 5, 31.3%). Conservative measures were trialed before surgery. Nine patients had "complete relief" following surgery and seven "improved." Conclusions: Posterior vertebral endplate fracture should be considered in differential diagnosis of a youth or young adult with back pain, radiating leg pain, and limited knee extension, regardless of symptom onset. For patients in whom conservative management fails, consultation with an experienced physician whose practice specializes in spine medicine is recommended.

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Traumatic lumbar vertebral ring apophysis fracture with disk herniation in an adolescent

Kadam

Narsinghpura

Deshmukh

et al. 2017

Radiology Case Reports

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We present a case of a 15-year-old male with history of back pain and bilateral lower limb radiculopathy due to fall. The magnetic resonance imaging scan showed disc bulge at L2-L3 level causing compression on contained nerve roots. In this case, computed tomography scan was indispensable for diagnosis and classification of the vertebral apophyseal fracture and to guide appropriate further management. Apophyseal ring fracture is an uncommon cause of back pain with radiculopathy in adolescents and athletes. High degree of suspicion is necessary to differentiate these injuries from disc herniation so as to further guide appropriate conservative or surgical management. The common cause of back pain in this population is related to musculoskeletal injuries. Lumbar disc herniation contributes to negligible number of cases in this age group, as against that seen in the adult population. An important and rare etiology to be considered for these patients includes vertebral ring apophyseal fracture.

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Fraturas com arrancamento do anel apofisário ("limbus") póstero-superior da vértebra L5, associado com hérnia discal pré-marginal em atletas

Cited by 6 publications

References 9 publications

Evaluation of Back Pain in Children

Evaluation of Back Pain in Children

Posterior Vertebral Endplate Fractures: A Retrospective Study on a Rare Etiology of Back Pain in Youth and Young Adults

Traumatic lumbar vertebral ring apophysis fracture with disk herniation in an adolescent

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