Surgical management of symptomatic low back pain and monoradicular leg pain in adolescent and young adult patients

Abstract

Ab stract: Ob jec ti ves:The pur po se of the pre s ent re t ro spec ti ve study is to draw at ten tion to symp to m a tic low back pain in ad o le s cent pa ti ents, in or der to en co ur a ge ear li er di ag no sis and sur gi cal tre at ment. The study as ses sed the ra di o lo g i cal, cli n i cal fe a tu res and sur gi cal out co mes of 13of this kind of pa ti ent. Ma te ri als and Met h ods:Out of a se ri es of 983 con se c u ti ve ca ses (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011) of lum bar disc ex ci sions from our ne u ro sur gi cal in sti tu tion, 13-1,32% of the pa ti ents we re be t we en the ages of 15 and 20 mean 17,84. Fif teen op e r a ti ons, in clu d ing two re o pe ra ti ons, we re per for med on this pa ti ent gro up, by a con ven ti onal mic ro sur gi cal pro ce du re. The in di ca ti ons for surgery we re fa i l u re of con ser va ti ve tre at ment, in trac ta ble pain and/or pro gres si ve ne u ro lo g i cal im pa ir ment.Re sults: Low back pain and mo no ra di cu lar sci a t ica we re the main com pla ints in 77%, but fin d ings of ne u ro lo g i cal de f i cits we re ra re -1 ca se. The sur gi cal fin d ings re ve a led a pro tru d ing disc in ele ven ca ses, one la t e ral re cess ste no sis and one lum bar syno vial cyst. Ini ti ally, all pa ti ents we re tre a ted con ser va ti vely by the ir phy si ci ans mo re than 3 months wit h o ut suc cess. On the day of dis char ge, Kir kaldy-Wil lis cri te ria results we re ex cel lent or good in 92% of pa ti ents. The fol low-up pe riod ran ged from 6 months to 2 years with an av e r a ge of 1 year and 2 months. The re sults we re excel lent in 10 pa ti ents and good in 3 pa ti ents.Di s cus sion: We de m on stra te that the ca u se of low back pain and mo no ra di cu lar leg pain in ad o le s cent pati ents may not only be a ca u se of her ni a ted lum bar disc or la t e ral re cess nar ro w ing. Very ra rely the se symptoms may be ca u sed by lum bar syno vial cysts.Con clu sion: Sur gi cal tre at ment of ad o le s cent pati ents is able to re li e ve the cli n i cal symp toms qu ickly.Cli n i cal symp toms such as low back pain and leg pain and the ne u ro lo gic de f i cit di s ap pe ar wit hin 3 months af ter sur gery.Key words: ad o le s cent, disk, her ni a tion, sur gery, tre at ment. IN TRO DUC TIONDe ge n e r a ti ve chan ges in the in ter ver te bral disc be gin at the la te te ens, af ter the com ple tion of the physi cal growth and de ve l op ment, du r ing which po s te ri or her ni a tion of the nu c le us pul po sus can ca u se sci a t i ca be ca u se of ner ve ro ot com pres sion (1). Symp to m a tic low back pain and mo no ra di cu lar leg pain are ra re in pa ti ents un der age of 20 years (2,3,4). The re are a num ber of dif fe r en tial di ag no ses to be con si d e red in pa ti ents with the men ti o ned com pla ints (5). Most of ten they are due to lum bar disc her ni a tion (LDH). An ot her ca u se of ra di cu lo pathy in ad o le s cents co uld be spi nal tu mors (5, 6). They are al s...