Separation of the lumbar vertebral rims.

概要

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10 cases with separation of the lumbar vertebral rims, 5 of the anterior separation and 5 of the posterior one, were radiologically and therapeutically discussed. Furthermore, the mechanism of the separation was dynamically presumed.All patients except one showed no response to conservative treatment. 5 patients of the anterior separation and one of the posterior separation had anterior fusion. 4 patients of the posterior separation had extensive laminectomy plus excision of bony fragment. Consequently, fusion cases oftained complete relief of pain whereas laminectomy cases remained persisting low back pain due to intervertebral instability.Computed tomogram clearly revealed common characteristics in both anterior and posterior separation.Anterior separation may be produced in the anteriorsuperior rim of L5. On the other hand, posterior separation in the posterior-inferior rim of L4.Concerning the mechaism of the separation, in flexion, shearing stress acts so as to split obliquely the posterior rim. On the other hand, in extension, the stress acts so as to split the anterior rim. Tensile stress acting on the rims may pull out the anterior or posterior rim. Compressive stress acts so as to push the nucleus pulposus into the split.
西日本整形・災害外科学会の論文