Neurospine.  2022 Sep;19(3):586-593. 10.14245/ns.2244346.173.

Posterior Apophyseal Ring Fracture in Adult Lumbar Disc Herniation: An 8-Year Experience in Minimally Invasive Surgical Management of 48 Cases

• Yuan S
• Wu Q
• Zang L
• Fan N
• Du P
• Wang A
• Wang T
• Si F
• Li J
• Kong X

• KMID: 2533786
• DOI: http://doi.org/10.14245/ns.2244346.173

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.

Keyword

Apophysis fracture; Disc herniation; Clinical outcome; Percutaneous endoscopic lumbar discectomy; Microsurgery