We are faced with a dilemma I hope you can help us figure out. Our 16-year-old son hurt his back during last season's track and field events. A CT scan shows he fractured the apophyseal ring in the L45 segment. He's still having quite a bit of pain. Would surgery to remove the damaged disc and broken fragments be helpful?
There isn't a lot of information available to help with treatment decisions for disc herniation in children and adolescents (teenagers) with apophyseal ring fractures. What little we do know suggests that apophyseal ring fractures don't always require surgery to remove the fragments.
Without surgery, large fragments in patients who have severe symptoms can result in chronic low back pain later on. Small fractures don't seem to have any long-term effects. In either case, the first step is to try conservative (nonoperative) care. Even if the X-rays or CT scans show extensive involvement, the surgeon must base treatment on the patient symptoms, not on radiologic studies.
Many young athletes have X-ray signs of apophyseal fractures without ever knowing they had an injury. These findings suggest that disc herniations with apophyseal fractures probably occur together at the same time. A traumatic injury may not be the most likely cause. It appears that chronic, repetitive physiologic stress on the disc and surrounding soft tissues is the real problem.