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Duke Orthopaedics
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Wheeless' Textbook of Orthopaedics

Slipped Vertebral Apophysis


- 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

Limbus lumbar vertebral fractures in 27 adolescents and adults

Avulsion of the cervical ring apophyses: acute and chronic appearance.

Radiology of posterior lumbar apophyseal ring fractures: report of 13 cases

Posterior lumbar apophyseal fractures.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, April 11, 2012 4:38 pm