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

Abstract

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.

Percutaneous endoscopic interlaminar discectomy for posterior ring apophyseal fracture accompanied with lumbar disc herniation in a 12-year pediatric diver: a case report

“…PRAF is a rare etiology of back pain in adolescents and young adults, and it is, unfortunately, ignored by many surgeons [1,3]. Trauma is considered a significant causative factor in about 50% of children and adolescents [1,5]. The main pathogenesis of the presented case included ring apophysis, and incompletely fused vertebral endplate following highintensity dive training.…”

“…PRAF is a rare etiology of back pain in adolescents and young adults, and it is, unfortunately, ignored by many surgeons [1,3]. Trauma is considered a significant causative factor in about 50% of children and adolescents [1,5].…”

“…The main pathogenesis of the presented case included ring apophysis, and incompletely fused vertebral endplate following highintensity dive training. PRAF mainly occurs at the L4-5 and L5-S1 disc levels [1,3,5]. PRAF diagnosis primarily depends on computed tomography (CT), and it can be classified into four sub-groups [3,6].…”

“…Posterior ring apophysis fractures (PRAF), accompanied with lumbar disc herniation (LDH), is relatively uncommon [1]. Severe PRAF will increase the risk of spinal deformity in growing children [2].…”

<p>Dorsal and ventral thoracic 12 vertebra body height is associated with incident lumbar vertebral fracture in postmenopausal osteoporotic women</p>

“…[1][2][3][4][5] The ability to predict risk factors for LVF is crucial because of the negative consequences of LVF that include chronic back pain, related functional disability, kyphosis, and height loss, all of which have major impacts on a patient's quality-of-life; as well as the associated increases in morbidity and mortalitiy. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Analysis of bone mineral density (BMD) using dual-energy X-ray absorptiometry (DEXA) is the most commonly used index of bone power, and a low BMD is the most important risk factor for LVF prediction. [21][22][23][24] But, almost 50% of LVF occurs in patients with BMD above the World Health Organization (WHO) diagnosis threshold of osteoporosis (T-score#2.5).…”