Apophyseal fracture of the lumbar spine in adolescence

A case of adolescent lumbar disc herniation with apophyseal fracture is reported. The patient, a 12-year-old boy, experienced sudden onset of pain during athletic activity. Examination revealed tenderness on palpation of the L-5 and S-1 spinous processes, straightening of the lumbar spine, and exquisite pain on 10 degrees of hyperextension. Straight leg raising, Lasègue's, and bowstring tests were all positive. Magnetic resonance imaging and computed tomography confirmed the diagnosis. Treatment included exercise, ibuprofen administration, and limitation of sports activity. At 23 months, the patient is symptom-free. A literature review of 20 cases with computed tomographic or myelographic diagnosis is presented, and conservative and surgical treatment programs are outlined.