Surgical Results of Lumbar Disc Herniation with Detached Ring Apophysis.

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Between 1984 and 1992, 15 cases (13 male, 2 female) of lumbar disc herniation (LDH) with detached ring apophysis were operated upon. The age at operation was 14 to 32 years (mean; 23. 1 years). The inferior endplate of L4 was involved in 11 patients, superior endplate of L5 in 2 patients, and elsewhere in the other two patients. Anterior interbody fusion (AIF) was performed in 12 cases, posterior lumbar interbody fusion (PLIF) with pedicle screws in 2 cases and posterolateral fusion (PLF) in 1 case.Complete removal of the detached ring apophysis was planned, because of the possibility that if it remained it may cause spinal canal stenosis in the future.The surgical LDH cases with detached ring apophysis were considered more serious than those with ordinary LDH.Disc degeneration was shown by X-ray, MRI and discography. Eleven cases suffering from low back pain and leg symptoms had developed the low back pain first, followed by the leg symptoms. Therefore it could be said that not only removal of the detached ring apophysis but also interbody fusion should be done.Good results were obtained in all procedures. However, AIF required twice the period of post-surgical treatment compared to PLIF, because the height of the vertebral body had been shaved off an average of 42% (range; 26-56%) in AIF.We concluded that PLIF with pedicle screws is the most suitable operation for LDH with detached ring apophysis.
西日本整形・災害外科学会の論文