Pediatric lumbar disc herniation: a report of two cases and review of the literature

Abstract

Background Lumbar disc herniation (LDH) is not a common condition in children. Most reports on pediatric LDH concern the outcomes of surgeries performed in children in whom nonsurgical treatment failed while the outcome of nonsurgical treatment of LDH in children was rarely reported. Cases presentation Case 1: a 10-year-old girl presented with back pain and sciatica in her left leg for over 3 months. The physical examination revealed exacerbation of back pain by waist extension or flexion, and a positive Lasegue’s sign was revealed in her left leg. Magnetic resonance imaging (MRI) revealed lumbar disc herniation at the L5/S1 level. She was diagnosed with LDH. After receiving nonsurgical treatment of traditional Chinese medicine (TCM) for 30 days, the girl had mild low back pain and sciatica and the symptoms had resolved completely at the 3-month follow-up. There was no recurrence within the following 2 years. MRI performed 30 months later revealed that the herniated disc did not shrink significantly. However, she was totally asymptomatic at the follow-up performed 30 months later. Case 2: a 13-year-old boy presented with sciatica in his left leg for over 3 months. The physical examination revealed that Lasegue’s sign was positive in the left leg, the level of muscle strength in the left ankle plantar flexors was grade 4. MRI revealed a lumbar disc herniation at the L5/S1 level. He was diagnosed with LDH. The boy underwent 2 weeks of TCM treatment, and exhibited a favorable outcome: only mild pain was noticed in his left buttocks after walking for more than 15 min. He was asymptomatic at the 3-month follow-up and there was no recurrence within the next 3 years. MRI scan performed at 40 months later showed no significant resorption of the herniated disc. However, he was totally asymptomatic at the follow-up performed 40 months later. Conclusions For the nonsurgical treatment of pediatric LDH, resorption of herniated discs is not necessary for favorable long-term outcomes, and children with symptomatic LDH may become asymptomatic without resorption.

Pediatrics severe low back pain by disc herniation: an uncommon entity

“…The first Indonesian case was described in 2022 in a 15-year-old patient who had been experiencing deteriorating back pain and left leg pain for more than 4 years [ 5 ]. Also in 2022, two Chinese cases were published [ 6 ]. Other authors had described 12 cases in 5 years [ 7 ], 70 cases in 4 years [ 3 ]; 74 cases in 10 years [ 8 ].…”

“…It sat at the L3L4 level in 3% of cases, L4L5 in 49% and L5S1 in 48% [ 8 ]. Other authors had an L5S1 level in all their two cases [ 6 ].…”

Children with back pain – a radiologist’s approach

“…Lumbar disc herniation (LDH) is not a common condition in children. The overall incidence of LDH in children is unknown, and the diagnosis of LDH is usually delayed in children compared with adults [ 7 ]. In the evaluated group, in 10 children (28%), changes associated with disc degeneration, scoliosis, or the presence of Torlov cysts were diagnosed as the basis of pain.…”

Pediatric lumbar disc herniation: A case series on diagnosis and management

“…A study by Wang et al. [22] reported to cases of pediatric lumbar disc herniation who were aged 10- and 13-year-old. Both patients underwent nonsurgical treatment and had favorable outcomes with no recurrence after follow-up.…”