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Khandge A, Kale A, Medapati S, Sharma P, Kulkarni K, Varma R. Posterior Ring Apophyseal Fracture (PRAF) in a 13-Year-Old Adolescent Girl Treated With Unilateral Biportal Endoscopy: A Case Report. Cureus 2024; 16:e69351. [PMID: 39411634 PMCID: PMC11475090 DOI: 10.7759/cureus.69351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Accepted: 09/13/2024] [Indexed: 10/19/2024] Open
Abstract
Posterior ring apophyseal fracture (PRAF) is a rare but significant cause of lower back pain and radiculopathy in adolescents, commonly occurring due to trauma or intense physical activity. This is a case report of a 13-year-old girl with PRAF associated with lumbar disc herniation (LDH) following a sports injury, emphasizing diagnostic challenges and surgical management. The patient underwent unilateral laminectomy for bilateral decompression through unilateral biportal endoscopy (UBE-ULBD) at the L4-L5 level. Postoperatively, the patient had significant clinical improvement in the visual analog scale (VAS) score for leg and back pain at one-month follow-up. Although rare, PRAF associated with LDH is an important differential diagnosis for post-traumatic lower back pain in adolescents. Accurate preoperative imaging and minimally invasive surgical techniques such as UBE-ULBD provide effective decompression and improved clinical outcomes, allowing for a quicker return to daily activities.
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Affiliation(s)
- Ashwinkumar Khandge
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Amit Kale
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - SomiReddy Medapati
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Pankaj Sharma
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Ketan Kulkarni
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Rishyendra Varma
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
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Li P, Shi Z, Jiang Y, Peng Z, Wang Y. Clinical Observation of 10-mm Endoscopic Minimally Invasive Interlaminar Decompression in the Treatment of Ossified Lumbar Spinal Stenosis. World Neurosurg 2024; 187:e129-e135. [PMID: 38621501 DOI: 10.1016/j.wneu.2024.04.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE This study aims to observe the safety and effectiveness of 10-mm endoscopic minimally invasive interlaminar decompression in the treatment of ossified lumbar spinal stenosis. METHODS The clinical data of 50 consecutive patients with ossified lumbar spinal stenosis were retrospectively analyzed. All patients underwent minimally invasive interlaminar decompression with 10-mm endoscope. Patient demographics, perioperative data, and clinical outcomes were recorded. Visual analog scale scores, Oswestry disability index scores, and modified Macnab criteria were used to assess clinical outcomes. The lateral recess angle, real spinal canal area, and effective intervertebral foramen area were used to assess the effect of decompression. RESULTS The mean age of all patients was 59.0 ± 12.3 years. The mean operative time and intraoperative blood loss were 43.7 ± 8.7 minutes and <20 ml, respectively. Two years after surgery, the leg pain Visual analog scale score decreased from 7.4 ± 1.0 to 1.6 ± 0.6 (P < 0.05) and the Oswestry disability index score decreased from 63.8 ± 7.6 to 21.7 ± 3.4 (P < 0.05). The lateral recess angle, real spinal canal area and effective intervertebral foramen area were significantly larger than before surgery (P < 0.05). The overall excellent and good rate at the last follow-up was 92.0% according to the modified Macnab criteria. CONCLUSIONS The 10-mm endoscopic minimally invasive interlaminar decompression can safely and effectively remove the ossification in the spinal canal and achieve adequate decompression in patients with ossified lumbar spinal stenosis.
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Affiliation(s)
- Pengfei Li
- Department of Orthopedic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Zhen Shi
- Department of Orthopedic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Yunduo Jiang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Zhibin Peng
- Department of Orthopedic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Yansong Wang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China; NHC Key Laboratory of Cell Transplantation, Harbin Medical University, Harbin, China; Heilongjiang Provincial Key Laboratory of Hard Tissue Development and Regeneration, Harbin Medical University, Harbin, China.
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Zhang B, Chen P, Zhong J, To MKT, Cheung KMC, Wu J. Percutaneous endoscopic lumbar discectomy in lumbar disc herniation with posterior ring apophysis fracture: A case report in a 15-year-old child. Medicine (Baltimore) 2023; 102:e36213. [PMID: 38206687 PMCID: PMC10754556 DOI: 10.1097/md.0000000000036213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/30/2023] [Indexed: 01/13/2024] Open
Abstract
RATIONALE Lumbar disc herniation (LDH) with posterior ring apophysis fracture (PRAF) is rather rare in children, and in all age-stratified LDH patients, the incidence of RAF was 5.3% to 7.5%. Interestingly, the incidence of LDH with RAF in children (15%-32%) is several times higher than in adults, the mis-diagnosis of which may lead to delayed treatment. PATIENT CONCERNS Here, we report a 15-year-old schoolboy who suffered from sudden low back pain and radiating pain in both lower limbs after sport activities. Symptoms persisted after 3 months of conservative treatment. Computer radiography and magnetic resonance imaging indicated central disc herniation with PRAF at L4-5. DIAGNOSIS LDH with PRAF. INTERVENTIONS The herniated disc and epiphyseal fragments were successfully excised by the percutaneous endoscopic lumbar discectomy minimal-invasive technique. OUTCOMES Surgery was successful. Symptoms were immediately relieved postoperatively with a wound of only about 7.0 mm. Discharged on the next day. No perioperative complications occurred. Moreover, the imaging and clinical outcomes were also more satisfactory during the post-operative 15 months outpatient follow-up. LESSONS Pediatric LDH with PRAF is extremely uncommon, and there is a lack of training among physicians for such cases, which may lead to delayed diagnosis and treatment. Once a diagnosis for LDH with PRAF is established, percutaneous endoscopic lumbar discectomy is a safe and effective minimally invasive treatment to be considered, and we hope that this technique can provide more assistance in the future.
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Affiliation(s)
- Baode Zhang
- Department of Orthopedics and Traumatology, The University of Hong Kong – Shenzhen Hospital (HKU-SZH), Shenzhen, Guangdong, China
| | - Peikai Chen
- Department of Orthopedics and Traumatology, The University of Hong Kong – Shenzhen Hospital (HKU-SZH), Shenzhen, Guangdong, China
- School of Biomedical Sciences, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Jiaquan Zhong
- Department of Orthopedics and Traumatology, The University of Hong Kong – Shenzhen Hospital (HKU-SZH), Shenzhen, Guangdong, China
| | - Michael Kai-Tsun To
- Department of Orthopedics and Traumatology, The University of Hong Kong – Shenzhen Hospital (HKU-SZH), Shenzhen, Guangdong, China
- Department of Orthopedics and Traumatology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Kenneth Man-Chee Cheung
- Department of Orthopedics and Traumatology, The University of Hong Kong – Shenzhen Hospital (HKU-SZH), Shenzhen, Guangdong, China
- Department of Orthopedics and Traumatology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Jianbin Wu
- Department of Orthopedics and Traumatology, The University of Hong Kong – Shenzhen Hospital (HKU-SZH), Shenzhen, Guangdong, China
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Deng GH. Construction and validation of a nomogram prediction model for chronic low back pain after PKP for lumbar compression fractures. Medicine (Baltimore) 2023; 102:e34752. [PMID: 37904425 PMCID: PMC10615451 DOI: 10.1097/md.0000000000034752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/24/2023] [Indexed: 11/01/2023] Open
Abstract
The aim was to study the independent risk factors for chronic low back pain after lumbar compression fractures undergoing percutaneous kyphoplasty (PKP), and to establish a nomogram prediction model accordingly. Data were collected from patients with lumbar compression fractures from January 2017 to December 2021 at the Affiliated Hospital of Xinjiang Medical University. Univariate and multivariate logistic regression analyses were used to determine the independent risk factors for chronic low back pain after receiving PKP for lumbar compression fractures, and the corresponding nomogram was established. Receiver operating characteristic (ROC) curves were plotted and area under the curve (AUC) was calculated, and calibration curves and decision curve analysis (DCA) were plotted to evaluate the model performance. A total of 792 patients with lumbar compression fractures were included in the study, and 188 patients had chronic postoperative low back pain, with an incidence of 23.74%. After univariate and multivariate logistic regression analysis, a total of 5 variables were identified as independent risk factors for chronic low back pain after undergoing PKP for lumbar compression fractures, namely having diabetes (OR, 1.607; 95% CI, 1.157-3.205), preoperative T value < -2.5 SD (OR, 2.697; 95% CI, 1.417-5.021), multiple lumbar fractures (OR, 1.815; 95% CI, 1.415-3.201), lumbar compression ≥ 50% (OR, 2.854; 95% CI, 1.411-6.524), and bone cement leakage (OR, 2.911; 95% CI, 1.715-6.817). The nomogram for chronic low back pain after PKP for lumbar compression fractures constructed in this study has good predictive accuracy and helps orthopedic surgeons to intervene earlier in patients at high risk of chronic low back pain after undergoing PKP for lumbar compression fractures.
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Affiliation(s)
- Guang-hua Deng
- Ya’an Hospital of Traditional Chinese Medicine, Sichuan, China
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Lecourtois C, Baudin-Tréhiou C, Blond L. Lumbosacral endplate contour defect is frequently observed concurrent with other lumbosacral abnormalities on spinal CT of French Bulldogs. Vet Radiol Ultrasound 2023; 64:813-822. [PMID: 37366604 DOI: 10.1111/vru.13271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 06/28/2023] Open
Abstract
Lumbosacral osteochondrosis has been previously described in large breed dogs with variable clinical signs. Its CT features are a contour defect at the dorsal aspect of either vertebral endplate, commonly with an adjacent fragment. Descriptions of this condition have not been previously published in an increasingly popular breed, French Bulldogs. Aims of this retrospective, descriptive, single center study were to evaluate CT lumbosacral abnormalities and the frequency of lumbosacral endplate contour defect in a large sample of French Bulldogs. The presence and location of lumbosacral endplate contour defect and the presence of a concurrent osseous fragment were recorded. Other abnormal CT findings such as L7-S1 disc herniation, cauda equina nerve roots compression or thickening, disc mineralization, endplate sclerosis, spondylosis deformans, S1 articular processes hypertrophy, transitional vertebrae, hemivertebrae, spina bifida, and block vertebrae were recorded. Lumbosacral CT abnormalities were present in 91.8% of dogs (168/183). The most common abnormality was an L7-S1 dorsal disc herniation (77.4%, 130/168). Among dogs with lumbosacral abnormalities, the frequency of a lumbosacral endplate contour defect was 47% (79/168). It mostly involved L7 (78.5%, 62/79) at its dorsolateral aspect (61.3%, 38/62). A mineralized fragment was identified in 62% of the defects (49/79). Endplate contour defects were most frequently seen with a concurrent disc herniation (93.7%, 74/79) causing nerve root compression in 63.3% (50/79) and with sclerosis (65.8%, 52/79). There was no definitive evidence of a relationship with clinical presentation in this sample of French Bulldogs; therefore, this finding should be interpreted with caution. The etiology remains unclear.
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Affiliation(s)
- Camille Lecourtois
- Department of Diagnostic Imaging, Centre Hospitalier Vétérinaire Languedocia, Montpellier, France
| | - Clément Baudin-Tréhiou
- Department of Diagnostic Imaging, Centre Hospitalier Vétérinaire Languedocia, Montpellier, France
| | - Laurent Blond
- Department of Diagnostic Imaging, Centre Hospitalier Vétérinaire Languedocia, Montpellier, France
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Inoue T, Inokuchi A, Izumi T, Imamura R, Hamada T, Nakamura K, Ebihara T, Inoue H, Kuroki Y, Arizono T. Co-existence of Lumbar Disc Herniation and Posterior Ring Apophyseal Fracture: It Is Not Rare and Computed Tomography Is Useful. Cureus 2023; 15:e35475. [PMID: 36999108 PMCID: PMC10043829 DOI: 10.7759/cureus.35475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2023] [Indexed: 02/27/2023] Open
Abstract
Introduction 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. Methods We 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. Results A 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. Conclusion This 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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Li R, Zhou H, Han H, Fu D, Zhan Z, Meng B. Percutaneous endoscopic lumbar discectomy as a treatment for lumbar disc herniation linked with posterior ring apophysis separation. Front Surg 2023; 9:1072444. [PMID: 36684320 PMCID: PMC9852759 DOI: 10.3389/fsurg.2022.1072444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/29/2022] [Indexed: 01/09/2023] Open
Abstract
Background Lumbar disc herniation (LDH) linked with posterior ring apophysis separation (PRAS) is a rare and distinct subset of disc herniation. Few studies have evaluated the clinical efficacy of percutaneous endoscopic lumbar discectomy (PELD), which is a procedure used to treat LDH linked with PRAS. Objectives To evaluate the clinical efficacy and safety of PELD in the treatment of LDH linked with PRAS. Methods Patients who met inclusion criteria (n = 67; 40 males and 27 females) underwent PELD. General and operation-related information and perioperative complications of the patients were recorded. Clinical efficacy was measured using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) during the follow-up period. Results The mean operation time was 118.04 ± 19.31 min and the mean blood loss was 22.84 ± 15.89 ml. The VAS and ODI scores continued to improve immediately after the surgery to the last follow-up. Four patients experienced postoperative complications i.e., herniation recurrences. The conditions of the patients with the complications improved after treatment. Conclusions PELD has reliable efficacy and safety in the treatment of LDH linked with PRAS.
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Wu H, Li T, Cao J, He D, Wu T, Liu J, Yuan J, Cheng X. Does Percutaneous Endoscopic Lumbar Discectomy for Adolescent Posterior Ring Apophysis Fracture Accompanied with Lumbar Disc Herniation Have Better Outcome Than Lumbar Disc Herniation Alone? J Pain Res 2023; 16:911-919. [PMID: 36960466 PMCID: PMC10028304 DOI: 10.2147/jpr.s380945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/07/2023] [Indexed: 03/17/2023] Open
Abstract
Objective This study aims to compare the efficacy of percutaneous endoscopic lumbar discectomy (PELD) in treating adolescent posterior ring apophysis fracture (APRAF) accompanied by lumbar disc herniation (LDH) and lumbar disc herniation alone. Methods Herein we present a case series of adolescent patients who underwent PELD surgery from June 2017 to September 2021. All patients were divided into two distinct groups (ie Group A and B), based on their preoperative Computed tomography (CT) scans. Group A included patients with PRAF (type III) accompanied by LDH. Group B patients had LDH alone. The general clinical characteristics, clinical outcomes, and complications in patients from the two groups were assessed and compared. Results Compared to before surgery, the back and leg visual analog scores (VAS) and Oswestry Disability Index (ODI) were markedly improved in both groups' patients at all follow-ups. Notably, no significant differences were observed in the back and leg VAS scores, and ODI values between the two groups at different time points after surgery. The mean intraoperative blood loss was significantly lower in Group B, relative to Group A. The mean operation time was significantly shorter in Group B, compared to Group A. There was no statistically significant difference in complication and recurrence rates between the two groups. Conclusion APRAF (type III) accompanied by LDH and LDH alone can obtain roughly equal surgical effects through PELD surgery and turns out to be a safe and effective surgical approach.
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Affiliation(s)
- Hui Wu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
| | - Tao Li
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
| | - Jian Cao
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
| | - Dingwen He
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
| | - Tianlong Wu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
| | - Jiahao Liu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
| | - Jinghong Yuan
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
| | - Xigao Cheng
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
- Correspondence: Xigao Cheng, Department of Orthopaedics Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China, 330006, Email
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Percutaneous endoscopic interlaminar discectomy for posterior ring apophyseal fracture accompanied with lumbar disc herniation in a 12-year pediatric diver: a case report. Childs Nerv Syst 2023; 39:275-278. [PMID: 35798908 PMCID: PMC9968678 DOI: 10.1007/s00381-022-05605-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/03/2022] [Indexed: 11/03/2022]
Abstract
Posterior ring apophysis fracture (PRAF), accompanied with lumbar disc herniation (LDH), is a rare occurrence. Owing to its rarity, there is no consensus on the treatment strategy for this condition. Differences mainly encompass the type of decompression method, the need for additional spinal fusion, the need for apophysis fragments or/and disc materials removal, and long-term efficacy, particularly, compared to LDH alone. Hence, the aim of this study was to describe a rare instance of PRAF with LDH in a 12-year-old professional diver, who was successfully treated with percutaneous endoscopic interlaminar discectomy (PEID), and to initiate a discussion involving several meaningful and related factors.
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Yuan S, Wu Q, Zang L, Fan N, Du P, Wang A, Wang T, Si F, Li J, Kong X. Posterior Apophyseal Ring Fracture in Adult Lumbar Disc Herniation: An 8-Year Experience in Minimally Invasive Surgical Management of 48 Cases. Neurospine 2022; 19:586-593. [PMID: 36203285 PMCID: PMC9537851 DOI: 10.14245/ns.2244346.173] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/13/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Posterior apophyseal ring fracture (PARF) is an uncommon disorder that is usually accompanied by lumbar disc herniation (LDH). The aim of this study to describe the 8-year experience of performing minimally invasive treatment of PARF, giving particular attention to surgical technique and clinical outcome. METHODS We reviewed 1,324 consecutive patients with LDH seen in our department between 2013 and 2020. Forty-eight patients (3.63%) were enrolled who were diagnosed with PARF associated with LDH and underwent transforminal endoscopic lumbar discectomy (TELD). Mean duration of the final postoperative follow-up was 5.1 years. The control group was comprised of 50 patients diagnosed with LDH without PARF at the same facility. Data on clinical outcomes were analyzed. RESULTS The mean operation time in the PARF group was 105.4 minutes, which was longer than the mean operation time of the control group (83.9 minutes) (p = 0.001). Surgical complications, including dural tears (6.3%) and surgical instrument rupture (4.2%) were more common in the PARF group (p = 0.025). However, there was no significant difference in the proportion of excellent and good results and recurrence rates between the LDH patients with and those without PARF, respectively. CONCLUSION TELD is a safe and effective minimally invasive approach for the treatment of PARF. However, minimally invasive techniques may require longer operation time and steeper learning curve for inexperienced surgeons. The separation and removal of bone fragments, a key step in the procedure, requires patience and care to prevent rupture, residual surgical instruments, and leakage of cerebrospinal fluid.
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Affiliation(s)
- Shuo Yuan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Qichao Wu
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lei Zang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China,Corresponding Author Lei Zang Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100043, China
| | - Ning Fan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Peng Du
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Aobo Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Tianyi Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Fangda Si
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jian Li
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiaochuan Kong
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Liu J, Zhu B, Chen L, Jing J, Tian D. Clinical effects of unilateral biportal endoscopic decompression for lumbar posterior apophyseal ring separation. Front Surg 2022; 9:948417. [PMID: 35965860 PMCID: PMC9367217 DOI: 10.3389/fsurg.2022.948417] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The purpose of the study was to investigate the feasibility and effects of unilateral biportal endoscopic decompression for lumbar posterior apophyseal ring separation (PARS). Methods Patients with lumbar PARS who received unilateral biportal endoscopic decompression from June 2020 to September 2021 were analyzed, including 11 females and 15 males. The clinical symptoms were consistent with the imaging findings. Operation time, length of postoperative hospital stay and complications were recorded, and the clinical efficacy was evaluated by Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and modified Macnab scale at preoperative, postoperative 1, 3, 6 months and the last follow-up. Results Preoperative VAS scores of low back pain were (5.04 ± 1.37) and respectively decreased to (2.81 ± 0.75), (2.35 ± 0.98), (1.65 ± 0.69) and (1.15 ± 0.68) at postoperative 1, 3, 6 months and at the last follow-up, and the difference was statistically significant (F = 127.317, P = 0.000). Preoperative VAS scores of lower limb pain were (6.92 ± 1.38) and respectively decreased to (2.88 ± 1.07), (2.54 ± 1.03), (1.81 ± 0.80) and (1.00 ± 0.69) at postoperative 1, 3, 6 months and at the last follow-up, and the difference was statistically significant (F = 285.289, P = 0.000). Preoperative ODI scores were (60.47 ± 8.89) and respectively decreased to (34.72 ± 4.13), (25.80 ± 3.65), (17.71 ± 3.41) and (5.65 ± 2.22) at postoperative 1, 3, 6 months and at the last follow-up, and the difference was statistically significant (F = 725.255, P = 0.000). According to the modified Macnab criteria, the final outcome was excellent in 22 cases, good in 3 cases, fair in 1 cases. 26 patients could return to work or normal activities within 3 weeks. Conclusions Unilateral biportal endoscopic decompression has the advantages of clear and wide field of vision, large operating space, relatively simple need of surgical instrument and convenient and flexible operation procedure. It can achieve excellent clinical results with favorable efficacy and safety and may become a new minimally invasive endoscopic treatment for lumbar PARS.
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Affiliation(s)
- Jianjun Liu
- The Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China
| | - Bin Zhu
- The Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China
| | - Lei Chen
- The Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China
| | - Juehua Jing
- The Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China
| | - Dasheng Tian
- The Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China
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Zhu G, Xu Y, Cui J, Tang J, Ren H, De L, Jiang X. Cave-in Decompression Technique in Percutaneous Endoscopic Transforaminal Discectomy for Ossification Occupation in Lumbar Spinal Canal: A retrospective analysis of 23 cases. Neurochirurgie 2022; 68:498-503. [PMID: 35477015 DOI: 10.1016/j.neuchi.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/01/2022] [Accepted: 03/18/2022] [Indexed: 11/26/2022]
Abstract
OBJECT Percutaneous endoscopic transforaminal discectomy (PETD) for the treatment of ossification occupation of the lumbar spinal canal is technically demanding. The purpose of this study was to describe an endoscopic cave-in decompression technique in PETD for ossification occupation of the lumbar spinal canal and to report the clinical results. METHODS From May 2018 to June 2020, 23 consecutive cases, diagnosed in our institution as ventral ossification in the lumbar spinal canal and treated with PETD, were evaluated. The endoscopic cave-in decompression technique was performed. We analyzed the clinical outcomes on a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). Perioperative data and complications rate were also recorded. RESULTS Mean follow-up was 15.7 ± 2.8 months. Mean preoperative VAS score for low-back pain was 5.65 ± 1.43, and decreased to 0.57 ± 0.5 at final follow-up. Mean preoperative VAS score for leg pain was 5.48 ± 1.38, and decreased to 0.56 ± 0.5 at final follow-up. Mean preoperative ODI score decreased from 33.04 ± 5.28 preoperatively to 8.7 ± 2.54 at last follow-up. One patient experienced transient postoperative hypoesthesia, and 1 developed a mild transient decline in muscle strength; both recovered progressively. Postoperative CT and MRI showed that the ossification was effectively removed and the nerve root and dural mater was completely decompressed in all cases. CONCLUSION The endoscopic cave-in decompression technique in PETD is a safe and effective treatment method for selected patients with ossification occupation of the lumbar spinal canal.
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Affiliation(s)
- Guangye Zhu
- First Clinical Medical College, Guangzhou University of Chinese Medicine, 510405 Guangzhou, China
| | - Yuerong Xu
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China
| | - Jianchao Cui
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China
| | - Jingjing Tang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China
| | - Hui Ren
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China
| | - Liang De
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China
| | - Xiaobing Jiang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China.
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Cordover JB, Fleisig GS, Raszewski JA, Dumont AS, Cordover AM. Return to sport after lumbar microdiscectomy in high school and college age athletes. World Neurosurg 2022; 163:e516-e521. [PMID: 35421588 DOI: 10.1016/j.wneu.2022.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/05/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous studies have reported return to play (RTP) rates for athletes after lumbar discectomy, but not specifically younger athletes. The purpose of this study was to evaluate RTP rate of young athletes after lumbar microdiscectomy. METHODS Medical records for a single spine surgeon were reviewed to identify lumbar microdiscectomy patients. Patients were included if they were 21 years old or younger at the time of surgery and were athletes. 38 patients (25 male, 13 female) were identified, with mean age at surgery of 19 years. Level of herniated nucleus pulposus, variant anatomy, degenerative change, gender, preoperative blocks, ring apophyseal fractures, and duration of symptoms from onset until surgery were recorded. Patients were contacted to determine when and if they RTP. RESULTS Most patients had degenerative changes at the time of surgery, with a mean Pfirrmann score of 2.2. The average time from onset of symptoms until surgery was 11 months. All patients were reached for follow-up at an average 51 months post-op. 71% returned to play at an average of 4.5 months. There were no statistical differences in Pfirrmann Grade and RTP rates between high school and collegiate athletes, between males and females, nor between patients with two-level and one-level discectomies. Pfirrmann Grade was not significantly different between patients who RTP and those who did not RTP. CONCLUSIONS The prognosis for returning to competitive sports after lumbar microdiscectomy in young athletes is good. RTP rate and Pfirrmann Grade were not related to gender, sport level, or discectomy level.
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Affiliation(s)
| | - Glenn S Fleisig
- American Sports Medicine Institute, Birmingham, Alabama, USA.
| | | | - Aaron S Dumont
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Andrew M Cordover
- Andrews Sports Medicine & Orthopaedic Center, Birmingham, Alabama, USA
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Mistry D, Munjal H, Ellika S, Chaturvedi A. Pediatric spine trauma: A comprehensive review. Clin Imaging 2022; 87:61-76. [DOI: 10.1016/j.clinimag.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 03/26/2022] [Accepted: 04/21/2022] [Indexed: 11/03/2022]
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15
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Paediatric lumbar disc herniation presenting as pseudo flexion deformity of the hip and knee: A case report. JOURNAL OF ORTHOPAEDIC REPORTS 2022. [DOI: 10.1016/j.jorep.2022.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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16
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Holmes RD, Walsh JP, Yan YY, Mallinson PI, Andrews GT, Munk PL, Ouellette HA. Imaging of Hockey-related Injuries of the Head, Neck, and Body. Semin Musculoskelet Radiol 2022; 26:28-40. [PMID: 35139557 DOI: 10.1055/s-0041-1731420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Hockey is a demanding contact sport with growing popularity around the world. This article is part of a review series in this issue of Seminars in Musculoskeletal Radiology that summarizes epidemiological research on the patterns of ice hockey injuries as well as provides pictorial examples for a radiologist's perspective. We focus on non-extremity pathologies which encompass many of the most devastating injuries of hockey, namely those involving the head, neck, face, spine, and body.
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Affiliation(s)
- R Davis Holmes
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - John P Walsh
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Yet Y Yan
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Paul I Mallinson
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Gordon T Andrews
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Peter L Munk
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Hugue A Ouellette
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
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17
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Wang YB, Chen SL, Cao C, Zhang K, Liu LM, Gao YZ. Percutaneous Transforaminal Endoscopic Discectomy and Fenestration Discectomy to Treat Posterior Ring Apophyseal Fractures: A Retrospective Cohort Study. Orthop Surg 2020; 12:1092-1099. [PMID: 32583556 PMCID: PMC7454149 DOI: 10.1111/os.12698] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 12/19/2022] Open
Abstract
Objective To compare the efficacy and safety of percutaneous transforaminal endoscopic discectomy (PTED) and fenestration discectomy (FD) for posterior ring apophyseal fractures (PRAF). Methods This study was a retrospective cohort control study. A total of 96 patients with lumbar PRAF who underwent surgical treatment at the Henan Provincial People's Hospital of Henan University from September 2013 to December 2017 were retrospectively examined, of which 51 were treated by PTED and 45 by FD. The average age of those in the PTED group was 28.24 years, including 38 males and 13 females. The average age of those in the FD group was 28.07 years, with 33 males and 12 females. Operation time, total blood loss, hospitalization days, preoperative and postoperative visual analog scale (VAS), and Oswestry disability index (ODI) scores were evaluated. Modified MacNab criteria were used to evaluate the clinical effect at the last follow‐up. Results Both operations were successful and no serious complications occurred. All patients were followed up for 12–30 (average 16.7 ± 3.2) months, and no patients were lost to follow‐up. No statistically significant difference was found in the mean age and gender between the PTED group and the FD group (P < 0.05). Operation time, total blood loss, and length of hospital stay were significantly lower in the PTED group (87.65 ± 13.15 min, 12.78 ± 4.95 mL, and 6.80 ± 1.67 days, respectively) than in the FD group (114.11 ± 14.39 min, 30.89 ± 7.09 mL, and 11.71 ± 1.98 days, respectively) (P < 0.05). The VAS and ODI scores of the two groups at postoperative day 1 (PTED: 3.82 ± 0.97, 37.73% ± 3.72%; FD: 3.62 ± 1.09, 36.62% ± 3.05%), and at 3 months (PTED: 2.90 ± 1.08, 26.02% ± 2.90%; FD: 3.07 ± 0.99, 27.16% ± 4.02%), 6 months (PTED: 2.31 ± 0.88, 22.53% ± 2.67%; FD: 2.36 ± 0.77, 21.18% ± 3.35%), and the last follow‐up (PTED: 1.90 ± 0.83, 19.88% ± 3.01%; FD: 1.89 ± 0.86, 18.22% ± 3.03%) were significantly different from the preoperative scores (PTED: 6.53 ± 1.00, 55.24% ± 4.54%; FD: 6.78 ± 1.31, 53.56% ± 5.73%) (P < 0.05). The VAS and ODI scores at 3 months postoperatively, 6 months postoperatively, and the last follow up were not significantly different between the two groups (P > 0.05). In the PTED group, 2 patients developed a transient nerve stimulation symptom within 1 day after surgery and 1 patient had recurrence at 3 months after surgery. In the FD group, 2 patients had severe dural ruptures due to adhesion during surgery, 1 patient developed infection complications, and 2 patients relapsed at 2 and 3 months after surgery. At the last follow‐up, the modified MacNab criteria for clinical effect were 93.3% and 94.1% in the FD and PTED groups, respectively. Conclusion While PTED has the same efficacy as FD for treating PRAF, it is associated with shorter operation time, less trauma, and quicker recovery.
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Affiliation(s)
- Yao-Bin Wang
- Department of Orthopaedics, Henan Provincial People's Hospital of Henan University, Zhengzhou, China
| | - Shu-Lian Chen
- Department of Orthopaedics, Henan Provincial People's Hospital of Henan University, Zhengzhou, China
| | - Chen Cao
- Department of Orthopaedics, Henan Provincial People's Hospital of Henan University, Zhengzhou, China
| | - Kai Zhang
- Department of Orthopaedics, Henan Provincial People's Hospital of Henan University, Zhengzhou, China
| | - Li-Min Liu
- Department of Orthopaedics, Henan Provincial People's Hospital of Henan University, Zhengzhou, China
| | - Yan-Zheng Gao
- Department of Orthopaedics, Henan Provincial People's Hospital of Henan University, Zhengzhou, China
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Wong JS, Lalam R, Cassar-Pullicino VN, Tyrrell PN, Singh J. Stress Injuries of the Spine in Sports. Semin Musculoskelet Radiol 2020; 24:262-276. [DOI: 10.1055/s-0040-1709484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractSpine sports stress injuries account for a significant amount of time loss at play in athletes, particularly if left unrecognized and allowed to progress. Spondylolysis makes up most of these stress injuries. This article focuses on spondylolysis, bringing together discussion from the literature on its pathomechanics and the different imaging modalities used in its diagnosis. Radiologists should be aware of the limitations and more importantly the roles of different imaging modalities in guiding and dictating the management of spondylolysis. Other stress-related injuries in the spine are also discussed including but not limited to pedicle fracture and apophyseal ring injury.
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Affiliation(s)
- Jenn Shiunn Wong
- Department of Radiology, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Radhesh Lalam
- Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
| | - Victor N. Cassar-Pullicino
- Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
| | | | - Jaspreet Singh
- Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
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19
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Peng C, Zhou C, Zhu K, Zhang H, Tu Q, Ma X, Liu L. Percutaneous Full Endoscopic Management of Lumbar Posterior Edge Separation in Adolescents. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2019; 159:181-186. [PMID: 31830771 DOI: 10.1055/a-1039-1830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Lumbar posterior edge separation is a common disorder with lumbar disc herniation (LDH) in adolescents. Over the years, there has been a lack of an acknowledged assessment and plan. The purpose of this study was to elucidate the feasibility of all sufferers who have received percutaneous full endoscopic treatment for lumbar posterior edge separation in adolescents. METHODS Case series of sufferers with lumbar posterior edge separation who underwent surgery in the Affiliated Hospital Qingdao University between February 2017 and December 2018 were reviewed, including 15 males and 9 females. Preoperative and postoperative visual analogue scale (VAS) scores and the Korean Version of the Oswestry disability index (K-ODI) scores were used to evaluate the clinical outcomes. RESULTS All sufferers were followed up for 6 to 12 months, with an average time of 10.7 months. The postoperative VAS scores of low back pain and leg pain and ODIs were significantly different from the preoperative scores (p < 0.05). According to the modified Mac Nab criteria, the results were excellent in 17 cases and good in 7 cases. CONCLUSIONS Percutaneous full endoscopic treatment can effectively achieve neurological functional recovery in sufferers with favorable efficacy and safety.
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Affiliation(s)
- Chen Peng
- Qingdao University, Qingdao University, Qingdao, China
| | - Chuanli Zhou
- Qingdao University, Qingdao University, Qingdao, China
| | - Kai Zhu
- Qingdao University, Qingdao University, Qingdao, China
| | - Hao Zhang
- Qingdao University, Qingdao University, Qingdao, China
| | - Qihao Tu
- Qingdao University, Qingdao University, Qingdao, China
| | - Xuexiao Ma
- Department of Spine Surgery, Affiliated Hospital of Medical College Qingdao University, Qingdao, Cocos (Keeling) Islands
| | - Lei Liu
- Qingdao University, Qingdao University, Qingdao, China
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Palliyil NS, Rai RR, Deogaonkar K. Limbus Vertebral Fracture Presenting as Cauda Equina Syndrome Masquerading An Acute Disc Prolapse - A Rare Case Report and Review of Literature. J Orthop Case Rep 2019; 8:38-40. [PMID: 30687660 PMCID: PMC6343561 DOI: 10.13107/jocr.2250-0685.1150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction: Limbus vertebral fracture is an uncommon injury described in adolescents. It refers to the separation of a bony fragment from the unfused ring apophysis of lumbar vertebral end plate. It usually presents with back pain with/without radiculopathy masquerading an acute disc prolapse. However, the presentation as acute cauda equina syndrome has seldom been reported. Case Report: A 15-year-old male presented to the casualty with a history of acute-onset low back pain and bilateral lower limb radicular pain with weakness, after lifting of a heavy Indian musical instrument (Dholak). This was associated with urinary retention and numbness in perineal region. Examination revealed L5 and S1 weakness with absent ankle jerks bilaterally. Bulbocavernosus reflex was absent. Emergency magnetic resonance imaging imaging was done, which revealed a limbus fracture of cephalad part of L4 vertebral body with displaced fragment into the spinal canal causing compression of the cauda equina. Emergency surgery was done in the form of L3-L4 midline interlaminar microscopic decompression. The patient had complete neurological recovery including the bladder control within 1 month of surgery. The patient had no functional deficits during follow-up at 3 and6 months. Dynamic radiographs taken at the end of 6 months did not show any sign of instability. Conclusion: When an adolescent patient with no previous history of backpain presents with acute cauda equina syndrome, a possibility of limbus fracture should also be considered. Early diagnosis and surgical decompression in such cases can bring about complete neurological recovery and excellent clinical outcome.
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Affiliation(s)
- Nigil Sadanandan Palliyil
- Department of Orthopaedics, P.D Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Ravi Ranjan Rai
- Department of Orthopaedics, P.D Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Kedar Deogaonkar
- Department of Orthopaedics, P.D Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
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21
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Zheng ZZ, Tu Z, Li Y, Dai Y, Wu PF, Jiang B, Xu J, Xiao S, Li L, Lv GH, Wang B. Full-Endoscopic Lumbar Discectomy for Lumbar Disc Herniation with Posterior Ring Apophysis Fracture: A Retrospective Study. World Neurosurg 2018; 124:S1878-8750(18)32877-8. [PMID: 30590214 DOI: 10.1016/j.wneu.2018.12.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The present retrospective study evaluated the clinical results of full-endoscopic lumbar discectomy (FELD) for the treatment of lumbar disc herniation (LDH) with lumbar posterior ring apophysis fracture (PRAF) using an interlaminar or a transforaminal approach at an inpatient surgery center. METHODS Patients with single-level LDH with type III PRAF who had undergone FELD using an interlaminar or a transforaminal approach from January 2010 to December 2015 were enrolled. The general data recorded included sex, age, location, surgical approach, operative time, hospital stay, perioperative complications, and recurrence. The presence of mobile and immobile fragments was documented. The clinical outcomes were evaluated using a visual analog scale for low back and leg pain. The Oswestry Disability Index was used for the functional assessment and the modified MacNab criteria for patient satisfaction. RESULTS FELD was performed successfully in all cases and no serious perioperative complications were observed. A mobile fragment of PRAS was present in 18 patients and an immobile fragment in 15 patients. Complications occurred in 2 of the 33 included patients; 1 dual tear (3.0%) and 1 transient dysesthesia (3.0%) that did not require further treatment. Recurrence developed in 1 patient (3.0%) and required reoperation. The visual analog scale and Oswestry Disability Index scores had significantly improved postoperatively at 3, 6, and 12 months and the final follow-up visit (P < 0.05). Using the modified MacNab criteria, an excellent or good rate of 93.4% was achieved. CONCLUSIONS FELD is a safe and effective minimally invasive approach for the treatment of LDH with type III PRAF. Sufficient preparation and experience are required to achieve satisfactory results.
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Affiliation(s)
- Zhen-Zhong Zheng
- Department of Spine Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhiming Tu
- Department of Spine Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Yawei Li
- Department of Spine Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Yuliang Dai
- Department of Spine Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Peng-Fei Wu
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, China
| | - Bing Jiang
- Department of Spine Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Jietao Xu
- Department of Spine Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Shipeng Xiao
- Department of Spine Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Lei Li
- Department of Spine Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Guo-Hua Lv
- Department of Spine Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Bing Wang
- Department of Spine Surgery, Second Xiangya Hospital, Central South University, Changsha, China.
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Seo YN, Heo YJ, Lee SM. The Characteristics and Incidence of Posterior Apophyseal Ring Fracture in Patients in Their Early Twenties With Herniated Lumbar Disc. Neurospine 2018; 15:138-143. [PMID: 29991243 PMCID: PMC6104734 DOI: 10.14245/ns.1836002.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 04/17/2018] [Indexed: 11/19/2022] Open
Abstract
Objective Posterior 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. Methods We 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. Results Of 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%). Conclusion We 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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Affiliation(s)
- Yoon Nae Seo
- Department of Radiology, Hanyang University Hanmaeum Changwon Hospital, Changwon, Korea
| | - Young Jin Heo
- Department of Radiology, Inje University Busan Paik Hospital, Busan, Korea
| | - Sang-Min Lee
- Department of Neurosurgery, Armed Force Busan Hospital, Busan, Korea
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Abstract
Lower back pain in young athletes is a common problem. The prevalence of back pain from different causes in adolescent age group is between 20% and 30%. However, the incidence of low back pain in young athletes varies widely in different sports. Overuse injuries are the most common cause of low back pain in young athletes. In case of overuse injuries, the cause and effect relationship between back pain and specific condition is often difficult to establish. In adolescent athletes, the most common underlying identified cause of low back pain is lumbar spondylolysis. During adolescent growth spurt, the severity of the pain generally correlates with adolescent growth spurt. Participation in sports starting at an early age and for a longer duration tends to increase the risk for back pain. Numerous conditions cause low back pain in athletes. These include acute trauma, chronic overuse or repetitive trauma, and referred pain. Our focus in here will be on selected conditions that cause recurrent or chronic low back pain.
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Affiliation(s)
- Dilip R Patel
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Elizabeth Kinsella
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
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Kadam G, Narsinghpura K, Deshmukh S, Desai S. Traumatic lumbar vertebral ring apophysis fracture with disk herniation in an adolescent. Radiol Case Rep 2017; 12:427-430. [PMID: 28491203 PMCID: PMC5417619 DOI: 10.1016/j.radcr.2016.11.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 11/25/2016] [Accepted: 11/26/2016] [Indexed: 11/18/2022] Open
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.
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Fournier J, Tsirikos AI. Paediatric spinal trauma: patterns of injury, clinical assessment and principles of treatment. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.mporth.2016.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Deleo T, Merotto S, Smith C, D’Angelo K. A posterior ring apophyseal fracture and disc herniation in a 21-year-old competitive basketball player: a case report. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2015; 59:373-382. [PMID: 26816414 PMCID: PMC4711330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To describe the diagnosis and management of a competitive male basketball player with discogenic low back pain and presence of an old posterior ring apophyseal fracture (PRAF). This case will highlight the importance of early recognition and considerations regarding patient management for this differential of radiating low back pain. CLINICAL FEATURES A 21-year-old provincial basketball player presented with recurrent radiating low back pain into the left groin and lower limb. After several weeks of persistent symptoms including pain, muscle weakness, and changes in the Achilles deep tendon reflex, imaging was obtained that revealed a large disc extrusion with an old posterior ring apophyseal fracture. In collaboration with a spine surgeon and family physician, the patient was treated using a conservative, multimodal approach. Treatment consisted of graded mobilizations, spinal manipulative therapy, interferential current, and soft tissue therapy to the lumbar spine. Rehabilitation exercises focused on centralizing symptoms and improving strength, proprioception and function of the lower limb. After a period of 8 weeks, the patient was able to complete all activities of daily living without pain in addition to returning to basketball practice. SUMMARY PRAF is a unique condition in the immature spine and recent evidence suggests that those involved in sports requiring repetitive motion of the lumbar spine may be at increased risk. The astute clinician must consider this differential in young populations presenting with discogenic low back pain, as a timely diagnosis and necessary referral may allow for effective conservative management to reduce symptoms. Equally as important, one must be aware of the complications from PRAF as a contributing source of low back pain and dysfunction into adulthood. Knowing when to refer for advanced imaging and/or a surgical consult given the variable clinical presentation and prognosis is an essential component to care.
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Affiliation(s)
- Trevor Deleo
- Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario
| | - Samuel Merotto
- Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario
| | - Colyn Smith
- Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario
| | - Kevin D’Angelo
- Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario
- Sports Sciences Resident, Division of Graduate Studies
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Comment on: Sciatica in the Young. Asian Spine J 2014; 8:704. [PMID: 25346828 PMCID: PMC4206825 DOI: 10.4184/asj.2014.8.5.704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 09/10/2014] [Indexed: 11/08/2022] Open
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Alvarenga JALDS, Ueta FTS, Del Curto D, Ueta RHS, Martins DE, Wajchenberg M, Puertas EB. Apophyseal ring fracture associated with two levels extruded disc herniation: case report and review of the literature. EINSTEIN-SAO PAULO 2014; 12:230-1. [PMID: 25003931 PMCID: PMC4891168 DOI: 10.1590/s1679-45082014rc2736] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Indexed: 11/21/2022] Open
Abstract
Apophyseal ring fractures are rare injuries that may be associated with lumbar disc herniation in young patients. We report a unique case in the literature of a 15-year-old male patient who played football and was admitted at our service complaining of sciatica radiating into the left leg. An apophysial ring injury of L5 vertebral body was observed. This injury caused two extruded disc herniation in adjacent levels. Surgical procedure was indicated after failure of conservative treatment.
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Affiliation(s)
| | | | - David Del Curto
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Delio Eulalio Martins
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Marcelo Wajchenberg
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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