Tubular approach to minimally invasive microdiscectomy for pediatric lumbar disc herniation

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Lumbar disc herniation (LDH) in the pediatric population is rare and exhibits unique characteristics compared with adult LDH. There are limited data regarding the safety and efficacy of minimally invasive surgery (MIS) using tubular retractors in pediatric patients with LDH. Here, the outcomes of MIS tubular microdiscectomy for the treatment of pediatric LDH are evaluated.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>Twelve consecutive pediatric patients with LDH were treated with MIS tubular microdiscectomy at the authors’ institution between July 2011 and October 2015. Data were gathered from retrospective chart review and from mail or electronic questionnaires. The Macnab criteria and the Oswestry Disability Index (ODI) were used for outcome measurements.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>The mean age at surgery was 17 ± 1.6 years (range 13–19 years). Seven patients were female (58%). Prior to surgical intervention, 100% of patients underwent conservative treatment, and 50% had epidural steroid injections. Preoperative low-back and leg pain, positive straight leg raise, and myotomal leg weakness were noted in 100%, 83%, and 67% of patients, respectively. The median duration of symptoms prior to surgery was 9 months (range 1–36 months). The LDH level was L5–S1 in 75% of patients and L4–5 in 25%. The mean ± SD operative time was 90 ± 21 minutes, the estimated blood loss was ≤ 25 ml in 92% of patients (maximum 50 ml), and no intraoperative or postoperative complications were noted at 30 days. The median hospital length of stay was 1 day (range 0–3 days). The median follow-up duration was 2.2 years (range 0–5.8 years). One patient experienced reherniation at 18 months after the initial operation and required a second same-level MIS tubular microdiscectomy to achieve resolution of symptoms. Of the 11 patients seen for follow-up, 10 patients (91%) reported excellent or good satisfaction according to the Macnab criteria at the last follow-up. Only 1 patient reported a fair level of satisfaction by using the same criteria. Seven patients completed an ODI evaluation at the last follow-up. For these 7 patients, the mean ODI low-back pain score was 19.7% (SEM 2.8%).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>To the authors’ knowledge, this is the longest outcomes study and the largest series of pediatric patients with LDH who were treated with MIS microdiscectomy using tubular retractors. These data suggest that MIS tubular microdiscectomy is safe and efficacious for pediatric LDH. Larger prospective cohort studies with longer follow-up are needed to better evaluate the long-term efficacy of MIS tubular microdiscectomy versus other open and MIS techniques for the treatment of pediatric LDH.</jats:p></jats:sec>

One‐Stage Percutaneous Endoscopic Lumbar Discectomy for Symptomatic Double‐Level Contiguous Adolescent Lumbar Disc Herniation

“…However, adolescent lumbar disc herniation can be explained by another cause such as micro‐trauma, because degeneration is infrequent in adolescents 21–23 . But in actual fact, the pathogenesis of adolescent lumbar disc herniation is unclear, trauma or sports‐related incidents, genetics and dysfunctional bio‐mechanical conditions (being overweight or being tall, congenital lumbosacral malformations) are likely contributory 21–25 . In our study, flattening of the sagittal lumbar curvature happened in seven cases (43.75%).…”

“…The distinguishing feature of adult lumbar disc herniation was a result of age‐related degenerative process of the spine. However, adolescent lumbar disc herniation can be explained by another cause such as micro‐trauma, because degeneration is infrequent in adolescents 21–23 . But in actual fact, the pathogenesis of adolescent lumbar disc herniation is unclear, trauma or sports‐related incidents, genetics and dysfunctional bio‐mechanical conditions (being overweight or being tall, congenital lumbosacral malformations) are likely contributory 21–25 .…”

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

“…However, ALDH must be explained another cause such as micro-trauma, because degeneration is infrequent in adolescents [22][23][24]. But in actual fact the pathogenesis of ALDH is unclear, trauma or sports-related incidents, genetics and dysfunctional bio-mechanical conditions ( being overweight, or being tall, congenital lumbosacral malformations ) are likely contributory [21][22][23][24][25]. This study indicated that students accounted for 77.7%, we speculate that hours spent sitting is a major risk factor due to increased axial load.…”

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

“…22,26,39 In the current study, 3-to 5-year follow-up revealed a success rate of 94.7%; this is consistent with the results of COD and MD in the literature. 22,26,27,33,35,39 Long-term studies have shown that the cumulative recurrence rate of isolated discectomy increases over time (Table 3), 22 but no study offers longterm outcomes of PED in adolescents. Whether PED leads to results different from other procedures warrants further research.…”

“…6 MD allows for a small skin incision and offers reduced traumatization, less likelihood of excessive discectomy, and limited root manipulation. 15 COD and MD appear to be equally effective for pediatric patients with regard to short-to medium-term success rates (COD, 83%-100%; 9,15, 24,29 MD, 98%-100% 15,27 ), although there seems to be somewhat more difference in long-term success rates, with studies showing rates of 67% and 96% following COD 17, 29 and 85% and 92% after MD. 24,34 PED has become an important procedure in adult LDH.…”