Cargando…

Co-existence of Lumbar Disc Herniation and Posterior Ring Apophyseal Fracture: It Is Not Rare and Computed Tomography Is Useful

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 wh...

Descripción completa

Detalles Bibliográficos
Autores principales: Inoue, Takahiro, Inokuchi, Akihiko, Izumi, Teiyu, Imamura, Ryuta, Hamada, Takahiro, Nakamura, Kimitaka, Ebihara, Toshihiro, Inoue, Hayato, Kuroki, Yosuke, Arizono, Takeshi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10043829/
https://www.ncbi.nlm.nih.gov/pubmed/36999108
http://dx.doi.org/10.7759/cureus.35475
_version_ 1784913236503560192
author Inoue, Takahiro
Inokuchi, Akihiko
Izumi, Teiyu
Imamura, Ryuta
Hamada, Takahiro
Nakamura, Kimitaka
Ebihara, Toshihiro
Inoue, Hayato
Kuroki, Yosuke
Arizono, Takeshi
author_facet Inoue, Takahiro
Inokuchi, Akihiko
Izumi, Teiyu
Imamura, Ryuta
Hamada, Takahiro
Nakamura, Kimitaka
Ebihara, Toshihiro
Inoue, Hayato
Kuroki, Yosuke
Arizono, Takeshi
author_sort Inoue, Takahiro
collection PubMed
description 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.
format Online
Article
Text
id pubmed-10043829
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Cureus
record_format MEDLINE/PubMed
spelling pubmed-100438292023-03-29 Co-existence of Lumbar Disc Herniation and Posterior Ring Apophyseal Fracture: It Is Not Rare and Computed Tomography Is Useful Inoue, Takahiro Inokuchi, Akihiko Izumi, Teiyu Imamura, Ryuta Hamada, Takahiro Nakamura, Kimitaka Ebihara, Toshihiro Inoue, Hayato Kuroki, Yosuke Arizono, Takeshi Cureus Radiology 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. Cureus 2023-02-26 /pmc/articles/PMC10043829/ /pubmed/36999108 http://dx.doi.org/10.7759/cureus.35475 Text en Copyright © 2023, Inoue et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Radiology
Inoue, Takahiro
Inokuchi, Akihiko
Izumi, Teiyu
Imamura, Ryuta
Hamada, Takahiro
Nakamura, Kimitaka
Ebihara, Toshihiro
Inoue, Hayato
Kuroki, Yosuke
Arizono, Takeshi
Co-existence of Lumbar Disc Herniation and Posterior Ring Apophyseal Fracture: It Is Not Rare and Computed Tomography Is Useful
title Co-existence of Lumbar Disc Herniation and Posterior Ring Apophyseal Fracture: It Is Not Rare and Computed Tomography Is Useful
title_full Co-existence of Lumbar Disc Herniation and Posterior Ring Apophyseal Fracture: It Is Not Rare and Computed Tomography Is Useful
title_fullStr Co-existence of Lumbar Disc Herniation and Posterior Ring Apophyseal Fracture: It Is Not Rare and Computed Tomography Is Useful
title_full_unstemmed Co-existence of Lumbar Disc Herniation and Posterior Ring Apophyseal Fracture: It Is Not Rare and Computed Tomography Is Useful
title_short Co-existence of Lumbar Disc Herniation and Posterior Ring Apophyseal Fracture: It Is Not Rare and Computed Tomography Is Useful
title_sort co-existence of lumbar disc herniation and posterior ring apophyseal fracture: it is not rare and computed tomography is useful
topic Radiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10043829/
https://www.ncbi.nlm.nih.gov/pubmed/36999108
http://dx.doi.org/10.7759/cureus.35475
work_keys_str_mv AT inouetakahiro coexistenceoflumbardischerniationandposteriorringapophysealfractureitisnotrareandcomputedtomographyisuseful
AT inokuchiakihiko coexistenceoflumbardischerniationandposteriorringapophysealfractureitisnotrareandcomputedtomographyisuseful
AT izumiteiyu coexistenceoflumbardischerniationandposteriorringapophysealfractureitisnotrareandcomputedtomographyisuseful
AT imamuraryuta coexistenceoflumbardischerniationandposteriorringapophysealfractureitisnotrareandcomputedtomographyisuseful
AT hamadatakahiro coexistenceoflumbardischerniationandposteriorringapophysealfractureitisnotrareandcomputedtomographyisuseful
AT nakamurakimitaka coexistenceoflumbardischerniationandposteriorringapophysealfractureitisnotrareandcomputedtomographyisuseful
AT ebiharatoshihiro coexistenceoflumbardischerniationandposteriorringapophysealfractureitisnotrareandcomputedtomographyisuseful
AT inouehayato coexistenceoflumbardischerniationandposteriorringapophysealfractureitisnotrareandcomputedtomographyisuseful
AT kurokiyosuke coexistenceoflumbardischerniationandposteriorringapophysealfractureitisnotrareandcomputedtomographyisuseful
AT arizonotakeshi coexistenceoflumbardischerniationandposteriorringapophysealfractureitisnotrareandcomputedtomographyisuseful