Posterior Ring Apophysis Fracture Associated with Lumbar Disc Herniation Treated by Immobile Bony Fragment Excision - A Case Report -

Woo Dong Nam; Jae Hwan Cho; Jemin Yi; Jaewoo Lee

doi:10.4184/jkss.2015.22.3.118

Journal List > J Korean Soc Spine Surg > v.22(3) > 1076056

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Nam, Cho, Yi, and Lee: Posterior Ring Apophysis Fracture Associated with Lumbar Disc Herniation Treated by Immobile Bony Fragment Excision - A Case Report -

Case Report

Journal of Korean Spine Surg 2015;22(3):118-122.

Published online: 21 September 2015

DOI: https://doi.org/10.4184/jkss.2015.22.3.118

Posterior Ring Apophysis Fracture Associated with Lumbar Disc Herniation Treated by Immobile Bony Fragment Excision - A Case Report -

Woo Dong Nam, M.D., Jae Hwan Cho, M.D.^∗, Jemin Yi, M.D., Jaewoo Lee, M.D.

Department of Orthopaedic Surgery, College of Medicine Kangwon National University, Chuncheon, Korea

^∗Department of Orthopaedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea

Corresponding author: Jemin Yi, M.D. Department of Orthopaedic Surgery, Kangwon National University Hospital 17-1 Hyoja 3-dong, Chuncheon 200-722, Korea TEL: +82-33-258-9209, FAX: +82-33-258-2149 E-mail: firekimdo@gmail.com

Received 12 January 2015 Revised 6 May 2015 Accepted 12 August 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

A case report.

Objectives

We report a case of posterior ring apophysis fracture (PRAF) with lumbar disc herniation treated by immobile bony fragment excision.

Summary of Literature Review

PRAF causes severe radiculopathy, so treating with surgery is common.

Materials and Methods

A 30-year-old male diagnosed with PRAF with lumbar disc herniation was treated with discectomy, but his clinical symptoms were not relieved. Consequently, bony fragment excision, extended laminectomy and interbody fusion were also done.

Results

Radicular pain was relieved and showed good clinical outcome.

Conclusions

When treating PRAF, bony fragment excision and extended laminectomy should be considered even if an immobile bony fragment exists.

Keywords: Posterior ring apophysis, Bony fragment, Interbody fusion

REFERENCES

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Fig. 1.

(A-B) A sagittal and axial T2 weighted MRI of L4-5 level shows herniated disc material and bony fragment (white arrow) located centrally and markedly occupying the spinal canal space. Bony defect (asterisk) was noted at the posterior endplate of L5.

Fig. 2.

An intraoperative microscopic photo shows adequate decompression at the lateral recess to the foramen and mobilization of the left L5 root.

Fig. 3.

(A-B) Postoperative MRI and CT show a decompressed left lateral recess.

Fig. 4.

(A-B) After second operation, a sagittal and axial MRI shows adequate decompression was done at the L4-5 level.

Fig. 5.

Postoperative views after three years, (A-B) The anteroposterior and lateral views of the plain radiograph show bony union.

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