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Apophyseal Ring Fracture
Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Synonyms

                • Vertebral apophyseal fracture (Fx), limbus vertebra (LV), endplate avulsion Fx, corner Fx, slipped vertebral apophysis, lumbar posterior marginal node
              • Definitions

                • Fx or avulsion of vertebral ring apophysis (RA) following injury in immature skeleton
                  • Fx of anterior ring termed limbus vertebra
                  • Fx of posterior ring termed posterior apophyseal ring Fx (PAR-Fx)

              IMAGING

              • General Features

                • Radiographic Findings

                  • CT Findings

                    • MR Findings

                      • Nonvascular Interventions

                        • Nuclear Medicine Findings

                          • Other Modality Findings

                            • Imaging Recommendations

                              DIFFERENTIAL DIAGNOSIS

                                PATHOLOGY

                                • General Features

                                  • Staging, Grading, & Classification

                                    • Gross Pathologic & Surgical Features

                                      • Microscopic Features

                                        CLINICAL ISSUES

                                        • Presentation

                                          • Demographics

                                            • Natural History & Prognosis

                                              • Treatment

                                                DIAGNOSTIC CHECKLIST

                                                • Image Interpretation Pearls

                                                  Selected References

                                                  1. Singhal A et al: Ring apophysis fracture in pediatric lumbar disc herniation: a common entity. Pediatr Neurosurg. 49(1):16-20, 2013
                                                  2. Wu X et al: A review of current treatment of lumbar posterior ring apophysis fracture with lumbar disc herniation. Eur Spine J. 22(3):475-88, 2013
                                                  3. Wu XY et al: Posterior lumbar ring apophysis fracture. Orthop Surg. 3(1):72-7, 2011
                                                  4. Chang CH et al: Clinical significance of ring apophysis fracture in adolescent lumbar disc herniation. Spine (Phila Pa 1976). 33(16):1750-4, 2008
                                                  5. Sairyo K et al: Three-dimensional finite element analysis of the pediatric lumbar spine. Part I: pathomechanism of apophyseal bony ring fracture. Eur Spine J. 15(6):923-9, 2006
                                                  6. Asazuma T et al: Lumbar disc herniation associated with separation of the posterior ring apophysis: analysis of five surgical cases and review of the literature. Acta Neurochir (Wien). 145(6):461-6; discussion 466, 2003
                                                  7. Mendez JS et al: Limbus lumbar and sacral vertebral fractures. Neurol Res. 24(2):139-44, 2002
                                                  8. Bonic EE et al: Posterior limbus fractures: five case reports and a review of selected published cases. J Manipulative Physiol Ther. 21(4):281-7, 1998
                                                  9. Martinez-Lage JF et al: Avulsed lumbar vertebral rim plate in an adolescent: trauma or malformation? Childs Nerv Syst. 14(3):131-4, 1998
                                                  10. Swischuk LE et al: Disk degenerative disease in childhood: Scheuermann's disease, Schmorl's nodes, and the limbus vertebra: MRI findings in 12 patients. Pediatr Radiol. 28(5):334-8, 1998
                                                  11. Talha A et al: Fracture of the vertebral limbus. Eur Spine J. 6(5):347-50, 1997
                                                  Related Anatomy
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                                                  Related Differential Diagnoses
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                                                  References
                                                  Tables

                                                  Tables

                                                  KEY FACTS

                                                  • Terminology

                                                    • Imaging

                                                      • Top Differential Diagnoses

                                                        • Pathology

                                                          • Clinical Issues

                                                            • Diagnostic Checklist

                                                              TERMINOLOGY

                                                              • Synonyms

                                                                • Vertebral apophyseal fracture (Fx), limbus vertebra (LV), endplate avulsion Fx, corner Fx, slipped vertebral apophysis, lumbar posterior marginal node
                                                              • Definitions

                                                                • Fx or avulsion of vertebral ring apophysis (RA) following injury in immature skeleton
                                                                  • Fx of anterior ring termed limbus vertebra
                                                                  • Fx of posterior ring termed posterior apophyseal ring Fx (PAR-Fx)

                                                              IMAGING

                                                              • General Features

                                                                • Radiographic Findings

                                                                  • CT Findings

                                                                    • MR Findings

                                                                      • Nonvascular Interventions

                                                                        • Nuclear Medicine Findings

                                                                          • Other Modality Findings

                                                                            • Imaging Recommendations

                                                                              DIFFERENTIAL DIAGNOSIS

                                                                                PATHOLOGY

                                                                                • General Features

                                                                                  • Staging, Grading, & Classification

                                                                                    • Gross Pathologic & Surgical Features

                                                                                      • Microscopic Features

                                                                                        CLINICAL ISSUES

                                                                                        • Presentation

                                                                                          • Demographics

                                                                                            • Natural History & Prognosis

                                                                                              • Treatment

                                                                                                DIAGNOSTIC CHECKLIST

                                                                                                • Image Interpretation Pearls

                                                                                                  Selected References

                                                                                                  1. Singhal A et al: Ring apophysis fracture in pediatric lumbar disc herniation: a common entity. Pediatr Neurosurg. 49(1):16-20, 2013
                                                                                                  2. Wu X et al: A review of current treatment of lumbar posterior ring apophysis fracture with lumbar disc herniation. Eur Spine J. 22(3):475-88, 2013
                                                                                                  3. Wu XY et al: Posterior lumbar ring apophysis fracture. Orthop Surg. 3(1):72-7, 2011
                                                                                                  4. Chang CH et al: Clinical significance of ring apophysis fracture in adolescent lumbar disc herniation. Spine (Phila Pa 1976). 33(16):1750-4, 2008
                                                                                                  5. Sairyo K et al: Three-dimensional finite element analysis of the pediatric lumbar spine. Part I: pathomechanism of apophyseal bony ring fracture. Eur Spine J. 15(6):923-9, 2006
                                                                                                  6. Asazuma T et al: Lumbar disc herniation associated with separation of the posterior ring apophysis: analysis of five surgical cases and review of the literature. Acta Neurochir (Wien). 145(6):461-6; discussion 466, 2003
                                                                                                  7. Mendez JS et al: Limbus lumbar and sacral vertebral fractures. Neurol Res. 24(2):139-44, 2002
                                                                                                  8. Bonic EE et al: Posterior limbus fractures: five case reports and a review of selected published cases. J Manipulative Physiol Ther. 21(4):281-7, 1998
                                                                                                  9. Martinez-Lage JF et al: Avulsed lumbar vertebral rim plate in an adolescent: trauma or malformation? Childs Nerv Syst. 14(3):131-4, 1998
                                                                                                  10. Swischuk LE et al: Disk degenerative disease in childhood: Scheuermann's disease, Schmorl's nodes, and the limbus vertebra: MRI findings in 12 patients. Pediatr Radiol. 28(5):334-8, 1998
                                                                                                  11. Talha A et al: Fracture of the vertebral limbus. Eur Spine J. 6(5):347-50, 1997