Long-term outcomes of lumbar posterior apophyseal end-plate lesions in children and adolescents.
BACKGROUND
A lesion of the lumbar posterior apophyseal end plate in children and adolescents causes symptoms similar to those associated with a herniated disc. However, the end-plate lesion and the herniated disc differ in terms of pathology. The purpose of this study was to clarify the long-term clinical and radiographic outcomes in children and adolescents who were treated either surgically or conservatively for a lumbar posterior apophyseal end-plate lesion.


METHODS
We identified twenty-four consecutive patients who had been treated in the sports clinic of our hospital. The mean age at the first medical examination was 14.5 years. The mean follow-up time was 13.8 years. The mean age at the time of final follow-up was 28.4 years. All twenty-four patients had symptomatic low back pain with sciatica. All but two were active in sports. Sixteen patients were treated conservatively, and eight patients underwent surgical intervention. Skeletal maturity was evaluated on the basis of the appearance of the secondary ossification center of L3.


RESULTS
The apophyseal stage ("A" stage), which was assigned when the secondary ossification center of the vertebral body was visible on radiographs, was seen most frequently. Both the surgically treated group and the conservatively treated group demonstrated progressive disc degeneration at the involved level. The average Roland-Morris Disability Questionnaire (RDQ) score was 1.3 for the patients treated conservatively and 1.8 for those treated surgically, a nonsignificant difference. One patient developed spinal stenosis after twelve years of conservative treatment. One patient treated surgically demonstrated severe lumbar instability. There were no significant associations between the magnetic resonance imaging (MRI) findings and RDQ scores. Histological examination of surgical specimens showed irregular alignment of the anulus fibrosus, with degenerative matrix and chondrocytes without a nucleus.


CONCLUSIONS
The long-term outcome for patients with a posterior end-plate lesion is favorable, regardless of whether it is treated surgically or nonsurgically.
Department of Orthopedics, University of Tokushima, Graduate School, Institute of Health Biosciences, 3-18-15 Kuramoto, Tokushima 770-8503, Japan. higasinogobi@yahoo.co.jp
Kosaku
K
Higashino
Koichi
K
Sairyo
Shinsuke
S
Katoh
Shyoichiro
S
Takao
Hirofumi
H
Kosaka
Natsuo
N
Yasui
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006132:Growth Plate / Q000002:abnormalities* / Q000000981:diagnostic imaging; D006801:Humans; D007403:Intervertebral Disc / Q000002:abnormalities* / Q000000981:diagnostic imaging; D017116:Low Back Pain / Q000209:etiology / Q000503:physiopathology; D008159:Lumbar Vertebrae / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008349:Manipulation, Orthopedic / Q000379:methods; D019637:Orthopedic Procedures / Q000379:methods; D010147:Pain Measurement; D020127:Recovery of Function / Q000502:physiology; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D013122:Spinal Diseases / Q000175:diagnosis / Q000534:rehabilitation* / Q000601:surgery*; D013130:Spinal Stenosis / Q000503:physiopathology; D018709:Statistics, Nonparametric; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult