Lumbar disc herniation associated with separation of the ring apophysis: is removal of the detached apophyses mandatory to achieve satisfactory results?

There are three questions to be addressed in lumbar disc herniation with separation of the ring apophysis: does this lesion occur only in adolescents, does any trauma predispose this lesion, and is removal of the detached apophyses mandatory to achieve satisfactory results? We prospectively investigated 32 consecutive patients (22 men, 10 women; mean age, 25.4 years; mean followup, 4 years 8 months). This lesion occurred not only in adolescents, but also in adults older than 30 years. Eight patients (25%) were younger than 20 years, whereas 14 patients (43.8%) were in the third decade, and 10 (31.2%) were in the fourth decade. Only five patients (15.6%) had antecedent traumatic episodes. Resection of the fragment did not influence the clinical results. Excision of the herniated disc and mobile bony fragment was done in 11 patients (34.4%). Discectomy alone was done in 21 patients (65.6%) with immobile bony fragments. Satisfactory results were obtained in both groups. Lumbar disc herniation with detachment of the ring apophysis can occur, without any relationship to trauma, in adults and adolescents. Removal of the bony fragment is not always needed to achieve satisfactory results.