Apophyseal ring fracture associated with two levels extruded disc herniation: case report and review of the literature / Fratura do anel apofisário associada à hérnia discal extrusa de dois níveis: relato de caso e revisão da literatura

Apophyseal ring fractures are rare injuries that may be associated with lumbar disc herniation in young patients. We report a unique case in the literature of a 15-year-old male patient who played football and was admitted at our service complaining of sciatica radiating into the left leg. An apophysial ring injury of L5 vertebral body was observed. This injury caused two extruded disc herniation in adjacent levels. Surgical procedure was indicated after failure of conservative treatment.

As fraturas do anel apofisário são lesões raras, que podem estar associadas à hérnia de disco lombar nos pacientes jovens. Apresentamos aqui um caso único na literatura de paciente de 15 anos, gênero masculino, praticante de futebol, com queixa de ciatalgia para o membro inferior esquerdo. Houve lesão do anel apofisário, nos planaltos superior e inferior do corpo vertebral de L5, ocasionando hérnias discais extrusas nos níveis adjacentes. O procedimento cirúrgico foi indicado após a falha do tratamento conservador.

PATHOLOGICAL FRACTURE OF LUMBAR VERTEBRA IN CHILDREN WITH ACUTE NEUROLOGICAL DEFICIT: CASE REPORT.

This study reports on a case of lymphoma in a 13-year-old patient who came to a consultation with lumbar pain. The patient had suffered low-intensity trauma in the lumbar region that resulted in persistent pain of progressive nature. In an emergency evaluation, radiographic examination showed a spinal fracture. The patient was then sent to the specialist outpatient clinic of the same hospital. The initial examinations confirmed the diagnosis of a pathological fracture surrounded by a tissue mass, thus indicating the presence of a tumor. Subsequently, the patient evolved with lower-limb paresthesia and urine retention, without any pathological diagnosis for the lesion. The patient then underwent emergency surgery to achieve stabilization and neurological decompression, and material from the lesion was sent for anatomopathological examination. The result from the anatomopathological examination suggested that the lesion was a small-cell tumor, although leaving some doubt. Immunohistochemistry defined the diagnosis of lymphoma. The patient was then sent for oncological treatment. The aim of this study was to report on a rare case of lymphoma in a child with an initial diagnosis of a pathological fracture in the lumbar spine. It is important to investigate fractures associated with mild trauma in children. Precise diagnosis results in effective attendance with better results for these patients. This patient underwent chemotherapy and achieved a good response, with positive repercussions for his prognosis.