Posterior lumbar ring apophysis fracture

Abstract

Lumbar posterior ring apophysis fracture (PRAF) is an uncommon cause of low back pain in the pediatric age group, and a detailed understanding of this disease is important for the orthopaedic surgeon because it is easily misdiagnosed. However, to date no comprehensive review of PRAF has been published. The majority of published reports are in the form of cases report generally targeted at either diagnosis or therapy, or both. In this essay, we comprehensively review the pathogenesis, clinical presentation, diagnosis and treatment of PRAF.

Figure 1

Plain radiograph. The arrow shows a large bone fragment lying in the spinal canal posterior to the lower endplate of the L₄ vertebra.

Figure 2

(a) A bone window and (b) a soft window from a CT scan. The arrows indicate a posterior bony fragment located at the border of the posterior endplate of L4 and a round defect in the bone adjoining the fracture site. This lesion is Type III according to Takata's classification.

Figure 3

(a) Sagittal section of T2‐weighted and (b) axial section of MRI demonstrating a huge central disc protrusion of L_4/5 and a bone fragment causing severe dual sac compression.