Limbus lumbar and sacral vertebral fractures

Abstract

We evaluated the fractures of the lumbar and sacral vertebral limbus by disc impingement at the peripheral ring apophysis in 23 adults associated with trauma in 16 of them. Lumbalgia, radicular pain and narrow canal symptoms are the presenting forms of this underdiagnosed pathology. CT is the best method of examination, while plain roentgenograms and MR are usually negative. Accurate diagnosis and surgical technique with larger exposure are needed to resect the fractured fragments and protruded disc material for decompressing the roots and the dural sac. Our results were very good on the majority of cases.

A review of current treatment of lumbar posterior ring apophysis fracture with lumbar disc herniation

“…Epstein et al [4] showed that trauma played a significant etiologic role in up to onehalf of the patients in their study. Mendez et al [20] found 60 % of traumatic antecedents ranging from simple falls to strenuous activities. However, many patients had not recalled a history of recent trauma episode or just complained of the symptoms many years previously.…”

“…Diagnostic accuracy rate may be affected by the age of the patient, the affected level, the size and shape of the fragment. Computed tomography (CT) scan has the best performance for the demonstration of the size, shape and location of fracture [1,20,35] (Fig. 2).…”

“…They found that there existed a correlation of the fracture type with the age. This classification was widely acknowledged and cited by many authors [12,16,20]. Epstein et al [4,10] modified it and added the type IV fracture (Fig.…”

“…Laminotomy or laminectomy was the mostly acceptable decompressive method used by most authors (Table 1). It was generally agreed in the literature that semi-laminotomy or laminectomy was indicated for posterolateral fracture, mostly the unilateral lesion (type III according to modified Takata classification and type II of Scarfo classification system) [10,20,23,24]. However, the limited intervention was proved to be inadequate to relieve the symptoms for the large and base-abroad fragment causing canal or foraminal stenosis.…”

“…However, the limited intervention was proved to be inadequate to relieve the symptoms for the large and base-abroad fragment causing canal or foraminal stenosis. Therefore, bilateral laminotomy or full laminectomy was required in cases of centrally located lesions (Types I, II and IV) suggested by many authors [6,10,20,[22][23][24][25]. For the fracture originated from the cephalad or caudad endplates, the extend resection of the superior or inferior adjacent lamina was necessary [10].…”