Department of Neurosurgery, Mohammed V Military Teaching Hospital, Mohammed V Souissi University, Rabat, Morocco.
J Neurosurg Spine. 2011 Apr;14(4):475-83. doi: 10.3171/2010.11.SPINE10392. Epub 2011 Feb 4.
The association of posterior ring apophysis separation (PRAS) with lumbar disc herniation (LDH) is uncommon and represents a true subgroup of disc herniation mainly seen in the adolescent population. The objective of this study was to describe a decade of experience in the care of adult patients with PRAS with LDH, giving particular attention to its diagnosis, surgical treatment, and outcome.
This retrospective study focuses on a case series of adult patients with PRAS associated with LDH who underwent surgery for lumbar disc disease in the author's neurosurgical department between 1999 and 2008. Posterior ring apophysis separation was diagnosed in 87 (5.35%) of 1625 patients surgically treated for LDH; these patients made up the PRAS group. During a 6-month period in 2005, LDH without PRAS was diagnosed in 89 consecutive patients at the same facility; these patients constituted the control group. Presenting symptoms, physical examination findings, and preoperative imaging results were obtained from medical records. Immediate operative results were assessed, as were complications, long-term outcome, and the need for repeat surgery.
This study is the first to document the distinguishing features between adult patients with and those without PRAS. The difference in average age was statistically significant (p < 0.001) between the study group (36.22 years) and the control group (44.30 years), as was the incidence of male patients (86.20% vs 71.91%, p = 0.020), incidence of military patients (74.71% vs 57.30%, p = 0.015), average duration of symptoms (16.13 vs 8.4 months, p = 0.016), and incidence of reactive scoliosis (19.54% vs 4.49%, p = 0.002). The most common anatomical location of disc herniation in the PRAS group was L5-S1 (51.72%) versus L4-L5 (53.93%) in the control group (p = 0.017). In terms of previous injury, motor deficits, back and/or leg pain, lateral or central location of LDH, mean anteroposterior diameter of disc herniation, hard or soft discs, and surgical complications, there was no statistical difference between the 2 patient groups. Similarly, there was no difference in recurrence rates and clinical outcomes between the patients with or without PRAS.
Posterior ring apophysis separation with LDH is probably more common in adults than is generally recognized. It must be suspected when young male patients with persistent sciatic scoliosis and no history of injury show signs of calcified LDH. Computed tomography scanning with sagittal reconstructions is the procedure of choice for diagnosing. The L5-S1 intervertebral disc level is most commonly affected, especially the superior endplate of S-1. This condition needs more extensive surgical exposure and resection to relieve the nerve impingement. The occurrence of an apophyseal lesion was not associated with recurrent disc herniation or a fair outcome.
椎弓根后缘崩裂（PRAS）与腰椎间盘突出症（LDH）的关联并不常见，它代表了一种真正的椎间盘突出亚组，主要见于青少年人群。本研究的目的是描述作者神经外科部门在过去十年中治疗成人 PRAS 合并 LDH 的经验，特别关注其诊断、手术治疗和结果。
本回顾性研究聚焦于一组在 1999 年至 2008 年间因腰椎间盘疾病在作者神经外科接受手术治疗的 PRAS 合并 LDH 的成年患者的病例系列。在 2005 年的 6 个月期间，在同一医疗机构诊断出 89 例无 PRAS 的连续 LDH 患者；这些患者构成了对照组。从病历中获得了患者的主要症状、体格检查结果和术前影像学结果。评估了即刻手术结果、并发症、长期结果和再次手术的需求。
这是首次记录有和无 PRAS 的成年患者之间的区别特征。研究组（36.22 岁）与对照组（44.30 岁）之间的平均年龄差异具有统计学意义（p < 0.001），男性患者的发生率（86.20% vs 71.91%，p = 0.020）、军人患者的发生率（74.71% vs 57.30%，p = 0.015）、症状平均持续时间（16.13 个月 vs 8.4 个月，p = 0.016）和反应性脊柱侧凸的发生率（19.54% vs 4.49%，p = 0.002）也具有统计学意义。在 PRAS 组中，椎间盘突出最常见的解剖部位是 L5-S1（51.72%），而对照组是 L4-L5（53.93%）（p = 0.017）。在既往损伤、运动缺陷、背部和/或腿部疼痛、LDH 的外侧或中央位置、椎间盘突出的平均前后径、硬或软椎间盘以及手术并发症方面，两组患者之间无统计学差异。同样，有无 PRAS 的患者的复发率和临床结果之间也没有差异。
椎弓根后缘崩裂合并 LDH 在成年人中可能比普遍认为的更为常见。当年轻男性患者出现持续性坐骨神经脊柱侧凸且无外伤史时，应怀疑存在这种疾病。选择矢状重建的计算机断层扫描是诊断的首选方法。最常见的受累椎间盘水平是 L5-S1，特别是 S-1 的上终板。这种情况需要更广泛的手术暴露和切除，以缓解神经压迫。发生椎弓根病变与复发性椎间盘突出或良好的结果无关。
