Posterior ring apophyseal fracture
Updates to Article Attributes
Posterior ring apophysis fractures occur in the immature skeleton, most commonly in the lumbar spine.
Epidemiology
Typically, adolescent males practicing sport activities.
Clinical presentation
- back pain
- sciatica
- muscle weakness related with root innervation
- association with Scheuermann disease
Pathology
The ring apophysis is the part of the vertebral body connected to intervertebral disc. It is firmly attached to disc fibrous annulus through Sharpey fibers and its ossification occurs at 4-6 years old.
In the first years of life, the junction between ring apophysis and the rest of vertebral body is made through a cartilage layer, that is only completely ossified around 18 years old, and this is a weak point.
Repeated trauma or stress forces can cause disc herniation through this layer causing ring apophysis fractures.
Radiographic features
CT
Considered best imaging modality. Findings include:
- osseous fragment displaced posteriorly to endplate with rectangular or arc shaped morphology on axial plane
- posterior endplate defect
- posterior disc herniation
MRI
- high T2/STIR signal of acute fracture
- corner defect on posterior endplate margin
- disc degeneration and loss of height
- best method to evaluate nerve root / cauda equina compression
Differential diagnosis
On imaging consider
- Schmorl's node
- disc calcification/ossification
- calcified disc fragment
- posterior osteophyte
-<li>association with <a title="Scheuermann disease" href="/articles/scheuermann-disease">Scheuermann disease</a>- +<li>association with <a href="/articles/scheuermann-disease">Scheuermann disease</a>
-</ul><h4>Pathology</h4><p>The ring apophysis is the part of the vertebral body connected to <a title="Intervertebral disc" href="/articles/intervertebral-disc">intervertebral disc</a>. It is firmly attached to disc fibrous annulus through Sharpey fibers and its ossification occurs at 4-6 years old.</p><p>In the first years of life, the junction between ring apophysis and the rest of vertebral body is made through a cartilage layer, that is only completely ossified around 18 years old, and this is a weak point.</p><p>Repeated trauma or stress forces can cause disc herniation through this layer causing ring apophysis fractures. </p><h4>Radiographic features</h4><h5>CT</h5><p>Considered best imaging modality. Findings include:</p><ul>- +</ul><h4>Pathology</h4><p>The ring apophysis is the part of the vertebral body connected to <a href="/articles/intervertebral-disc">intervertebral disc</a>. It is firmly attached to disc fibrous annulus through Sharpey fibers and its ossification occurs at 4-6 years old.</p><p>In the first years of life, the junction between ring apophysis and the rest of vertebral body is made through a cartilage layer, that is only completely ossified around 18 years old, and this is a weak point.</p><p>Repeated trauma or stress forces can cause disc herniation through this layer causing ring apophysis fractures. </p><h4>Radiographic features</h4><h5>CT</h5><p>Considered best imaging modality. Findings include:</p><ul>
-<li>best method to evaluate nerve root / <a title="Cauda equina compression" href="/articles/cauda-equina-syndrome">cauda equina compression</a>- +<li>best method to evaluate nerve root / <a href="/articles/cauda-equina-syndrome">cauda equina compression</a>
-</ul><h4>Differential diagnosis</h4><ul>-<li>Schmorl's node</li>- +</ul><h4>Differential diagnosis</h4><p>On imaging consider</p><ul>
- +<li><a href="/articles/schmorl-nodes">Schmorl's node</a></li>
Image 1 CT (non-contrast) ( create )
Unable to process the form. Check for errors and try again.