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KMID : 1037920230100020067
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Arthroscopy and Orthopedic Sports Medicine
2023 Volume.10 No. 2 p.67 ~ p.72
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Apophyseal ring fractures on adolescents at a single center: mid- to long-term follow-up study
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Kim Byung-Ho
Cho Sung-Tan
Yu Oh-Jun
Kim Jin-Hwan
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Abstract
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Background: Apophyseal ring fractures (ARFs) are a rare disease typically found in adolescents and caused by microtraumas due to repetitious activities, especially in young active athletes. This study aimed to analyze our experience in the treatment and outcome of the disease at a single center for mid- to long-term follow-up.
Methods: This study retrospectively analyzed 649 patients < 18 years old who presented with lower back pain between 2001 and 2022. Clinical symptoms and patient characteristics were recorded along with functional outcomes. The diagnosis was confirmed by radiologic evaluation with magnetic resonance imaging and/or computed tomography. Surgical treatment was performed after conservative treatment failure.
Results: Twenty-eight (4.3%) patients with ARF were diagnosed, with a mean age at diagnosis of 14.9 years. Male patients (21 cases, 75.0%) were three times more prevalent than female patients (7 cases, 25.0%). The mean follow-up period was 39.7 months. Radiating pain was the most common symptom (15 cases). Ten cases presented neurologic symptoms (motor weakness). The most affected sites were the L5 upper endplate (13 cases) and S1 upper endplate (13 cases). There were 8 cases (28.5%) preceded by sports-related trauma. Patients who did not respond to conservative treatment or showed worsening neurologic symptoms underwent surgery, including chemonucleolysis (6 cases) and discectomy (6 cases). All patients showed improvement in subjective symptoms, including pain, until the final follow-up. There were no cases of neurologic sequelae after treatment.
Conclusion: ARF is a potentially prevalent cause of lower back pain in adolescents. ARF can be reliably treated with conservative and operative methods. Practitioners should be aware of ARF to ensure accurate diagnosis and proper treatment.
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KEYWORD
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Apophysis, Lower back pain, Adolescents, Sports
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