Surgical Treatments for Lumbar Disc Disease in Adolescent Patients; Chemonucleolysis / Microsurgical Discectomy / PLIF with Cages

Abstract

The herniated lumbar disc (HLD) in adolescent patients is characterized by typical discogenic pain that originates from a soft herniated disc. It is frequently related to back trauma, and sometimes it is also combined with a degenerative process and a bony spur such as posterior Schmorl's node. Chemonucleolysis is an excellent minimally invasive treatment having these criteria: leg pain rather than back pain, severe limitation on the straight leg raising test (SLRT), and soft disc protrusion on computed tomography (CT). Microsurgical discectomy is useful in the cases of extruded or sequestered HLD and lateral recess stenosis due to bony spur because the nerve root is not decompressed with chymopapain. Spinal fusion, like as PLIF, should be considered in the cases of severe disc degeneration, instability, and stenosis due to posterior central bony spur. In our study, 185 adolescent patients, whose follow-up period was more than 1 year (the range was 1 - 4 years), underwent spinal surgery due to HLD from March, 1998 to December, 2002 at our institute. Among these cases, we performed chemonucleolysis in 65 cases, microsurgical discectomy in 94 cases, and posterior lumbar interbody fusion (PLIF) with cages in 33 cases including 7 reoperation cases. The clinical success rate was 91% for chemonucleolysis, 95% for microsurgical disectomy, and 89% for PLIF with cages, and there were no nonunion cases for the PLIF patients with cages. In adolescent HLD, chemonucleolysis was the 1st choice of treatment because the soft adolescent HLD was effectively treated with chemonucleolysis, especially when the patient satisfied the chemonucleolysis indications.

Lumbar Disc Herniation in Adolescence

“…There are several reasons for this approach. A major one is that the growing spine is more vulnerable to surgical trauma, and iatrogenic deformities can develop after laminectomy in young patients [25, 26]. Surgery is recommended as first-line treatment only for individuals who present with marked neurological deficits.…”

“…Surgery is recommended as first-line treatment only for individuals who present with marked neurological deficits. If a young patient with disc herniation does require surgery, one-sided hemilaminotomy and discectomy is the preferred technique and any excessive bone or ligament resection may lead to instability in future [20, 25, 27, 28]. …”

Lumbar Disc Herniation in Fourteen Years Old Girl

“…Surgery is necessary if there is severe refractory pain after 4 -6 weeks of conservative treatment, progressive neurologic impairment, and cauda equina compression syndrome (23,24). However, conservative treatment is still generally recommended as the first-line treatment for LDH in children and adolescents without neurologic deficits because iatrogenic deformities can develop after surgical intervention in the growing spine (8,25,26). In conclusion, we emphasize the need to carefully evaluate low back pain in children and use comprehensive conservative treatment for first-line management.…”

“…The abnormalities that may be associated with lumbar disc herniation include occult spina bifida, extra-lumbar vertebra, sacralization, spinal and lateral recess stenosis, and spondylolisthesis (10). The initial treatment of LDH in children is similar to that of adults unless LDH affects the patient's neurologic condition, in which case early surgical intervention must be performed (11).…”

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

“…Even though FDA agreement for chymopapain use in humans has lengthy been reserved, it is still being contrived and in clinical usage in Korea, Canada, Australia, UK and three states in the US (41). In contrast by operation, chemonucleolysis is beneficial in that it is related with fewer disturbance and postoperative adhesion, smaller hospital stay, earlier remobilization and lower cost.…”