Posterior retroextramarginal disc hernia (PREMDH): Definition, diagnosis, and treatment

Scarfo, Giovanni Battista; Muzii, Vitaliano Francesco; Mariottini, Aldo; Bolognini, Andrea; Cartolari, R.

doi:10.1016/0090-3019(96)00154-1

Cited by 21 publications

(8 citation statements)

References 9 publications

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“…The large stress under this situation may damage and weaken the apophyseal ring in young ages and finally cause PARF, when it goes over the point that apophyseal ring physiologically endured [ 13 , 14 ]. The others reported that the pathogenesis of this disease is the degeneration of the intervertebral disc and cartilage [ 15 , 16 ]. We suggest the pathogenesis of this disease to be microtrauma and degeneration.…”

Section: Discussionmentioning

confidence: 99%

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The Characteristics and Incidence of Posterior Apophyseal Ring Fracture in Patients in Their Early Twenties With Herniated Lumbar Disc

2018

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ObjectivePosterior apophyseal ring fracture (PARF) is a common disorder that may be accompanied by herniated lumbar disc (HLD) in patients in their early twenties. However, there are very few reports on PARF in this clinical context. The objective of this study was to identify the incidence and characteristics of PARF with HLD in this age group. MethodsWe surveyed patients who visited Armed Forces Busan Hospital between May 2017 and October 2017 and included those aged between 19 and 25 years who had HLD accompanied by PARF. We retrospectively collected their demographic characteristics, clinical manifestations, and radiological findings on computed tomography (CT) scans. We categorized the PARF lesions according to Takata’s classification. ResultsOf 140 HLD patients, 43 (30.7%) had PARF lesions with HLD. We found that the presence of a PARF lesion was significantly related to a severe pain score on the visual analogue scale for lower back pain and/or lower leg radiating pain (p=0.001). The most common level and location of PARF were L5/S1 (n=25, 56.8%) and the superior endplate of the S1 vertebra, respectively. Type 1, according to Takata’s classification, was the most common type of PARF in the patients (n=34, 77.2%). ConclusionWe recommend that spinal surgeons perform CT scans to check for PARF lesions in all young patients in their 20s who present with severe radiating and lower back pain.

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Section: Discussionmentioning

confidence: 99%

“…Some revealed that the prevalence of PARF in children and adolescents was 5.8%–28% [ 7 , 8 ]. Scarfo et al [ 16 ] reported that 11% of patients with HLD were diagnosed with PARF. In our reports, PARF lesion was diagnosed in 43 patients with HLD, who were in their young twenties (30.7%).…”

Section: Discussionmentioning

confidence: 99%

The Characteristics and Incidence of Posterior Apophyseal Ring Fracture in Patients in Their Early Twenties With Herniated Lumbar Disc

2018

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“…Though few previous authors have observed fracture of vertebral rim in the pathogenesis of LDH, 21–25 Rajasekaran et al 9 first classified the endplate junctional failure associated with LDH. In this study, we used the 3D FSPGR sequence to evaluate the endplate cartilage and found it to have excellent sensitivity and specificity for detection of endplate failure.…”

Section: Discussionmentioning

confidence: 99%

“…6–9,17–19 Most of these previous studies used computed tomography (CT) scan to evaluate EPF, which can increase the radiation and cost. 9,20–24 …”

Section: Introductionmentioning

confidence: 99%

Significance of Vertebral Endplate Failure in Symptomatic Lumbar Disc Herniation

Sahoo

Mahapatra

Kaur

et al. 2017

Global Spine Journal

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Study Design:Prospective cohort study.Objective:Endplate lesions though have been implicated in the genesis of lumbar disc herniation (LDH), very little is known regarding their clinical course. Thus, the present study is aimed to investigate the incidence and types of endplate failure (EPF) in LDH and its correlation with the clinical symptoms and prognosis.Methods:Clinical and magnetic resonance imaging (MRI) features of 66 patients with isolated single level LDH were studied. Three-dimensional fast spoiled gradient (3D FSPGR) MRI and computed tomography scans were used to identify the bony and cartilaginous EPF. Twenty-five patients were operated on and 41 patients were treated conservatively. Changes in the pain score, function and neurology were noted at 3, 6, 12, 24, and 36 weeks.Results:Endplate lesions were observed in 64 patients (96.9%), including bony endplate failure (bony failure) in 47 patients (71.2%) and isolated cartilaginous endplate lesions in 17 patients (25.7%). Bony failure group had similar pain and functional scores but more severe neurological deficit at the initial evaluation. Clinical parameters improved in all groups, but the recovery was lesser in conservatively treated bony failure patients.Conclusion:Endplate lesions are commonly associated with symptomatic LDH. Presence of bony failure can increase neurological deficit and reduce the chance of recovery with conservative management. The 3D FSPGR sequence of MRI can be successfully used for detection of the endplate lesions in the herniated disc.

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“…There is no consensus on whether decompression requires herniorrhaphy alone, simultaneous fragment removal, or extensive laminectomy with fusion. However, the treatments available for PRAF with LDH have not yet been fully investigated [ 5 , 15 - 20 ]. Shirado et al [ 17 ] reported that good results can be obtained with herniotomy alone and that bone fragment resection is not mandatory.…”

Section: Discussionmentioning

confidence: 99%

Co-existence of Lumbar Disc Herniation and Posterior Ring Apophyseal Fracture: It Is Not Rare and Computed Tomography Is Useful

Inoue¹,

Inokuchi²,

Izumi³

et al. 2023

Cureus

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Posterior ring apophyseal fracture (PRAF) is characterized by the separation of bone fragments and sometimes coexists with lumbar disc herniation (LDH). However, how often these conditions coexist and the details of the clinical course remain unclear. MethodsWe analyzed 200 patients who underwent surgical treatment for LDH at our hospital from January 2016 to December 2020. Among these, we reviewed 21 patients who underwent microendoscopic surgery to treat PRAF. They consisted of 11 male and 10 female patients, ranging in age from 15 to 63 years. The average age was 32.8 months, and the average follow-up period was 39.8 years. We performed simple roentgenography and magnetic resonance imaging for all patients and computed tomography for about 80% of the patients. We evaluated the type of PRAF fragment (Takata classification), disease level, Japanese Orthopedic Association (JOA) score, Roland-Morris Disability Questionnaire (RDQ) score, operating time, intraoperative blood loss, and perioperative complications. ResultsA total of 10.5% of patients with LDH also had PRAF. The mean JOA score significantly improved from 10.6 ± 5.7 points before surgery to 21.4 ± 5.1 points at the final observation (p < 0.05). The mean RDQ score significantly improved from 17.1 ± 4.5 preoperatively to 5.5 ± 0.5 at the final observation (p < 0.05). The average operation time was 88.6 minutes. There were no complications requiring early surgery that were due to postoperative infection or epidural hematoma, but one patient required reoperation. ConclusionThis study showed that PRAF coexisted with LDH in about 10% of cases, and the outcomes of surgical treatment were generally good. Computed tomography is recommended to improve the diagnostic rate and assist with surgical planning and intraoperative decision-making.

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Posterior retroextramarginal disc hernia (PREMDH): Definition, diagnosis, and treatment

Cited by 21 publications

References 9 publications

The Characteristics and Incidence of Posterior Apophyseal Ring Fracture in Patients in Their Early Twenties With Herniated Lumbar Disc

The Characteristics and Incidence of Posterior Apophyseal Ring Fracture in Patients in Their Early Twenties With Herniated Lumbar Disc

Significance of Vertebral Endplate Failure in Symptomatic Lumbar Disc Herniation

Co-existence of Lumbar Disc Herniation and Posterior Ring Apophyseal Fracture: It Is Not Rare and Computed Tomography Is Useful

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