Posterior Ring Apophysis Separation (PRAS) : A relatively rare clinical entity in adolescents & young adults

Kolakshyapati Manish

Adhikari Rupendra B

Takeda Masaaki

Yamaguchi Satoshi

Morishige Mizuki

Kurisu Kaoru

Nepal Journal of Neuroscience

Herniated Lumbar Disc (HLD) may be associated with separation of the posterior ring apophysis of the adjacent vertebral body. It is often diffi cult to diagnose radiologically and may be confused with calcifi cation of the posterior vertebral structures. We report a 32 years old male, presenting with a history of low back pain radiating to the left lower limb and associated with tingling sensation and paresthesia. Magnetic Resonance Imaging (MRI) of lumbosacral (LS) spine revealed left L5-S1 lateral disc herniation compressing the exiting nerve root. CT scan with sagittal reconstruction of LS spine revealed PRAS of upper lip of S1 vertebra. L5 partial laminectomy and microdiscectomy with removal of the loose bony fragment was done. Post-operative MRI demonstrated decompression of the spinal canal and the neural foramen. We report this case to familiarize the clinicians with this clinical entity as it requires strong clinical suspicion coupled with sagittal reconstruction CT scan for diagnosis and extensive exposure with removal of loose fragments together with discectomy for adequate relief of the symptoms.

CT with sagittal reconstruction

HLD

MRI

PRAS

Medical sciences [ 490 ]

eng

Neuroscience Publishing Group

(c) Neuroscience Publishing Group

[ISSN] 1813-1948