- Discussion:
- slipped vertebral apophysis usually occurs in lower lumbar spine;
- limbus vertebral frx occur when fusion between vertebral ring apophysis and central cartilage
is incomplete or delayed;
- ring apophysis w/ adjacent disc is displaced into vertebral canal;
- apophysis remain suseptible to fragmentation in both adolescents and young adults;
- associated w/ heavy lifting and vigorous physical activities;
- sciatica is more common in avulsion fracture of the cephalic posterior vertebral body than in the caudal portion;
- Exam:
- pt typically has signs & symptoms of acute herniated disc;
- X-ray:
- may show small bone frag (which represents edge of ring apophysis) w/ in spinal canal;
- limbus vertebral frxs are only rarely diagnosed on plain x-rays;
- CT Scan:
- dx is is best made w/ imaging studies or with
myelography;
- Diff Dx: disc herniation
- Treatment:
- conservative treatment is usually unsuccessful, & most pts require operative excision of the disc and ring apophysis;
- simple disc excision is not adequate;
- posterior vertebral body apophyseal avulsion frxs that cause sciatica should be removed;
Fracture of the posterior margin of a lumbar vertebral body.
Fracture of the lumbar vertebral apophysis.
OM Sovio et al.
J. Pediatric Orthopedics. Vol 5(5) 1985. p 550-552.
Limbus lumbar vertebral fractures in 27 adolescents and adults.
NE Epstein and JA Epstein.
Spine. Vol 16. 1991. p 962-966.
Avulsion of the cervical ring apophyses: acute and chronic appearance.
K Johnson et al. Skeletal Radiology.
Vol 20(3). 1991. p 207-210.
Radiology of posterior lumbar apophyseal ring fractures: report of 13 cases.
JL Dieteman et al. Neuroradiology. Vol 30(4) 1988. p 337-344.
Posterior lumbar apophyseal fractures. Radiology 130:629-633, 1979
Handel S, Twiford T, Reigel D, et al:
