J Korean Soc Spine Surg.  2015 Sep;22(3):118-122. 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

• Nam WD
• Cho JH
• Yi J
• Lee J

• KMID: 2068931
• DOI: http://doi.org/10.4184/jkss.2015.22.3.118

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.

Keyword

Posterior ring apophysis; Bony fragment; Interbody fusion

MeSH Terms

Adult
Diskectomy
Humans
Laminectomy
Male
Radiculopathy

Figure

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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.

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  Fig. 2. An intraoperative microscopic photo shows adequate decompression at the lateral recess to the foramen and mobilization of the left L5 root.

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  Fig. 3. (A-B) Postoperative MRI and CT show a decompressed left lateral recess.

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  Fig. 4. (A-B) After second operation, a sagittal and axial MRI shows adequate decompression was done at the L4-5 level.

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  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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