Lumbar disc herniation associated with scoliosis in a 15-year-old girl: case report

Abstract

-Intervertebral disc herniation is a rare condition in childhood and adolescence, although some cases have already been reported in the literature. We present the case of a 15 year-old-girl with low back pain and scoliosis. She had no previous history of trauma or collagen diseases. MRI showed L4-L5 and L5-S1 disc herniations and no further bone and structural changes. After two level discectomy, pain ceased and scoliosis improved, without further treatment. Based on her evolution and on what has already been reported in literature, we consider that scoliosis associated with disc herniation in young patients is most likely to be only an anthalgic position, not indicative of further structural changes.KEY WORDS: lumbar disc herniation, low back pain, scoliosis, adolescence.Hérnia de disco lombar associada a escoliose em uma jovem de 15 anos: relato de caso RESUMO -Hérnia de disco intervertebral é condição rara em crianças e adolescentes. Alguns relatos isolados e algumas séries foram publicadas. Descrevemos o caso de uma paciente de 15 anos, sem antecedentes relevantes, que apresentou hérnia de disco intervertebral em dois níveis lombares (L4-L5 e L5-S1) associada a escoliose não estrutural que melhorou após a cirurgia, sem necessidade de órtese. Baseados neste caso e no que encontramos na literatura, acreditamos que escoliose associada a hérnia de disco em jovens é resultante apenas de posição antiálgica, não representando necessariamente alteração estrutural. PALAVRAS-CHAVE: hérnia de disco lombar, escoliose, adolescente. Intervertebral disc herniation is a rare condition in children and adolescents. Wahren (1946) was the first to report a case of a disc herniation surgery in a 12 years old boy. Since then, some single cases and series have been reported [1][2][3][4][5][6] . Less than 1% of lumbar disc herniation surgery occur in patients between 10 and 20 years old and only 0.5% of these discectomies are performed in patients under 16 years. Most of these patients (40% to 70%) have a history of traumatic injuries to the lumbar spine, usually related to sport activity, falls (higher than 1m) and motor vehicle accidents. In patients under sixteen, about 2% of the cases occur at the L3-L4 level and 98% are distributed equally between L4-L5 and L5-S1 levels 7 . Pain relieve posture is described in nearly 20% of pediatrics patients with lumbar disc herniation, whereby scoliosis is usually present, with the convexity turned to the affected side 4 .We report the case of a 15-year-old girl, with no previous history of spinal disease, who presented with a non-traumatic intervertebral disc herniation in two lumbar levels (L4-L5 and L5-S1), associated with a non structural scoliosis, that improved after surgery, without need of further treatment. CASEA 15 years old girl, caucasian, otherwise healthy, with no history of previous spinal disease, was admitted with difficulty to walk and low back pain ("stabbing"), with diffuse irradiation to the left leg. The onset of symptoms occurred four months before. The pain ...

Scoliosis may increase the risk of recurrence of lumbar disc herniation after microdiscectomy

“…Only case reports exist in the literature to associate scoliosis with LDH. 11,19 It is still uncertain about the mechanism and frequency of LDH in patients with scoliosis. This study therefore attempted to demonstrate for the first time the association between scoliosis and recurrent LDH in young adults.…”

Pediatric Lumbar Disc Herniation: A Review of Manifestations, Diagnosis and Management

“…Inside the NP, a richness of proteoglycans permits absorption of water. This possessions of the NP is vital for the IVD's management of axial loads (5).…”

“…Educations have exposed that among 13% and 57% of adolescents with LDH have a first-degree relation by the similar complaint (22,23). Vertebral abnormalities such as scoliosis, and transitional vertebra are recognized to be related with LDH in children and adolescents (24), even though their pressure has not been measured. Also, there were a few trainings representative of the connotation of epiphyseal ring division with pediatric LDH, with described simultaneous rate up to 40% (23,24).…”

“…Vertebral abnormalities such as scoliosis, and transitional vertebra are recognized to be related with LDH in children and adolescents (24), even though their pressure has not been measured. Also, there were a few trainings representative of the connotation of epiphyseal ring division with pediatric LDH, with described simultaneous rate up to 40% (23,24). Hence, no variance in clinical consequence was noticed among patients with or without slipped epiphysis (25).…”

“…This is in contrast with the adult population where the disc degeneration commonly precedes the onset of symptomatic disc herniation. A genetic cause is also suspected with 13% -57% of exaggerated teenagers being reported as having a first-degree relation with the similar complaint (5,8). Lumbar disc herniation in children has been associated with transitional vertebrae, scoliosis and other vertebrae anomalies even though these influences have not been quantified.…”