Percutaneous endoscopic discectomy in adolescent lumbar disc herniation: a 3- to 5-year study

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The authors sought to investigate the efficiency of percutaneous endoscopic discectomy (PED) in adolescent patients with lumbar disc herniation (LDH), compare PED outcomes in adolescent patients with those in young adult LDH patients as controls, and discuss relevant technical notes.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>This was a retrospective study involving 19 adolescent LDH patients (age &gt; 13 and &lt; 18 years, 20 discectomies) and 38 young adults (age &lt; 40 years, 38 discectomies) who also had LDH and were matched to the adolescent group for sex and body mass index. The combined cohort included 51 male patients (89.5%) and 6 female patients (10.5%), with an average age of 26.7 years (range 14–39 years). The operated levels included L3–4 in 1 patient (1.7%), L4–5 in 22 patients (37.9%), and L5–S1 in 35 patients (60.4%). Two adolescents (10.5%) exhibited apophyseal ring separation and one (5.3%) had had previous PED. All patients underwent PED under local anesthesia. Outcomes were evaluated through a visual analog scale (VAS), the Japanese Orthopaedic Association (JOA) scoring system, and the modified MacNab grading system.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>The mean duration of follow-up was 41.7 months (range 36–65 months). The outcomes in adolescents were satisfactory and comparable with previously reported outcomes of microsurgical discectomy (MD) and conventional open discectomy (COD). The adolescent patients had a faster and better recovery course than the adult patients (p &lt; 0.01). One adolescent patient (5.3%) exhibited recurrence and 2 adults (5.3%) experienced transient dysesthesia; the complication rates were comparable in the 2 age groups (p = 0.47). Prolonged duration of symptoms (p &lt; 0.01) and disc degeneration (p = 0.01) were correlated with lower postoperative JOA values; patients with extrusions had higher postoperative JOA values than those with protrusions (p = 0.01).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>PED may yield favorable results in the treatment of adolescent LDH in terms of short- to medium-term follow-up; restricted discectomy and a conservative rehabilitation program might be advisable. Further long-term studies are warranted to address this rare disease entity.</jats:p></jats:sec>

Short-term clinical outcomes of percutaneous transforaminal endoscopic discectomy in treating adolescents under 25 years old with massive lumbar disc herniation

“…PTED is a better minimally invasive surgical method, compared with fenestration discectomy (FD), with such advantages as less trauma, 1ess blood loss,early function recovery,1ess effect on lumbar spinal stability. It is a safe and effective minimally invasive technique for adolescent lumbar disc herniation (ALDH), and the outcomes of PTED are similar to that of FD, which is also recognized by other authors [10][11][12]. However, few publications reported the efficacy of PTED in the treatment of adolescent patients with massive LDH.…”

Endoscopic transforaminal lumbar interbody fusion in the treatment of degenerative lumbar spondylolisthesis

“…Endoscopic and open procedure of lumbar spine has its advantages and limitations, and the decision about which been performed should mainly be based on the pathologic features of the lumbar. [21][22][23] Degenerative lumbar spondylolisthesis in adults is characterized by the loss of disk height across the affected segment with sagittal translational and is often coupled with rotational deformity. [5] The goal of the surgical treatment of spondylolisthesis was stabilization of the motion segment, decompression of neural elements, reconstitution of disk space height, and restoration of sagittal plane translational and rotational alignment.…”

Full-endoscopic lumbar discectomy for two contiguous level adolescent lumbar disc herniation

“…Appropriate conservative treatment including (bed rest, physical therapy and (NSAIDs) is the rst choice for adolescents, but the young patients do not respond as well to nonsurgical treatment as adults due to adolescent disk material often remains well hydrated [13][14][15]. The surgical aim of treatment for ALDH is achieving of appreciable pain relief and function improvement.…”