When is the appropriate time for surgical intervention of the herniated lumbar disc in the adolescent?

Fakouri, Bahram; Nnadi, Colin; Boszczyk, Bronek M.; Kunsky, Alexander; Cacciola, Francesco

doi:10.1016/j.jocn.2009.01.023

Cited by 17 publications

(15 citation statements)

References 18 publications

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“…Published studies have reiterated that adolescents, as opposed to adults, are less responsive to conservative treatment of LDH [4,10,17], which is mainly attributed to the high elasticity and viscosity of the disc material in adolescents compared with that in adults [23]. Kurihara et al reviewed 70 adolescents with lumbar disc herniation [18].…”

Section: Discussionmentioning

confidence: 99%

“…Although genetic predisposition [6,7] and trauma [8,9] have been reported as causes of LDH in adolescents, the etiology remains an area of continuing debate. The clinical features of LDH in adolescents, characterized with broader spectrum of symptoms, are typically different from those in adults [10,11]. Besides low back pain and leg pain, scoliotic posture, difficulty in walking and paravertebral muscle spasm are also frequent complaints in children and adolescents with LDH.…”

Section: Introductionmentioning

confidence: 99%

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Scoliotic posture as the initial symptom in adolescents with lumbar disc herniation: its curve pattern and natural history after lumbar discectomy

Zhu

Zhao

Wang

et al. 2011

BMC Musculoskelet Disord

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BackgroundThere have been few studies focusing on the curve pattern of scoliosis caused by lumbar disc herniation (LDH) in adolescents and the natural history of scoliosis after discectomy. The current study was carried out to identify the curve pattern of scoliosis and investigate the effect of posterior discectomy on the curve improvement in adolescents with LDH.MethodsThis review focused on a group of 26 adolescents with LDH who initially presented to our clinic for evaluation of scoliosis, followed by posterior discectomy between 2000 and 2009. Radiographic measurements included curve pattern, specific curve features, trunk shift, and sagittal profile. The correlation between the side of disc herniation and the direction of lumbosacral curve and the trunk shift was evaluated.ResultsA typical curve pattern was initially identified in all of the patients as a short lumbosacral curve accompanied with a long thoracic or thoracolumbar curve toward the opposite side. 23 of 26 patients (88.5%) had a trunk shift more than 2.0 cm away from the midline, showing a poor coronal balance. A relatively straight sagittal profile was noted in all the patients. 84.6% (22/26) patients had a disc herniation at the convex side of lumbosacral curve. Similarly, 73.1% (19/26) patients showed a trunk shift toward the opposite side of disc herniation. All of the patients had an marked curve improvement immediately after discectomy. In the 17 patients with a more than 2-year follow-up, only two had a residual lumbosacral curve greater than or equal to 20 degrees. The mean ODI improved from 21.4% before surgery to 7.3% at the final follow-up.ConclusionsA short lumbosacral curve accompanied with a long thoracic or thoracolumbar curve toward the opposite side, and a relatively straight sagittal profile have been noted in all the patients. The direction of lumbosacral curve and trunk shift was related to the side of disc herniation. A majority of patients have a small curve size while assosiated with a significant coronal imbalance. Earlier decompression can provide a greater opportunity for spontaneous correction of scoliosis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Scoliotic posture as the initial symptom in adolescents with lumbar disc herniation: its curve pattern and natural history after lumbar discectomy

Zhu

Zhao

Wang

et al. 2011

BMC Musculoskelet Disord

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“…Symptomatic treatment with rest, analgesics, and physical therapy is successful in the majority of patients but adolescents do not fare as well with conservative therapy as do adults. Early microdiscectomy for patients who do not respond to conservative treatment is advocated by some surgeons while others reserve operative therapy for progressive neurologic deficit [23]. …”

Section: Pain From the Anterior Elements Of The Spinementioning

confidence: 99%

Review for the generalist: evaluation of low back pain in children and adolescents

Houghton

2010

Pediatr Rheumatol

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Back pain is common in children and adolescents. Most cases of back pain are non-specific and self-limiting. In children and adolescents, pain is usually related to the posterior elements of the spine and disc-related problems are rare. Serious pathology, including malignancy and infection needs to be excluded. Evaluation and management is challenging and requires a thorough history and physical exam, and understanding of the immature skeleton. Diagnostic imaging is useful in the evaluation of a child or adolescent with low back pain and can help guide management. This article will review common causes of back pain in the pediatric population.

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Mao

Zhu

Wu³

et al. 2020

Preprint

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Background Symptomatic lumbar disc herniation is rarely seen among adolescents. Adolescent lumbar disc herniation (ALDH) accounts for 0.5–6.8% of all those treated. Evidently, to our knowledge, no studies have emphasized the operative technique to treat two contiguous level adolescent lumbar disc herniation simultaneously. In this study, we aim to investigate the feasibility and advantages of one-stage full-endoscopic lumbar discectomy(FELD)for two contiguous level ALDH. This is the first paper, to my knowledge, dealing with two contiguous level ALDH simultaneously with one-stage full-endoscopic lumbar discectomy. Methods Between January 2014 and December 2019, patients received FELD surgery for lumbar disc herniation (LDH) in 2 main minimally invasive spine center of China were selected for screening of this study. Data of 5877 cases were retrospectively analyzed (2780 cases and 3097 cases, respectively). The inclusion criteria were patient under 21-year old, two contiguous level symptomatic lumbar disc herniation received one-stage 2 level PELD surgery. Visual analog scale (VAS) scores and modified Macnab criteria were used to assess the preoperative and postoperative clinical results. Results 11 patients were enrolled in this study (0.19%,11/5877), 8 patients were male and 3 were female. 9 patients with LDH in the same side underwent single-incision 2 level FELD surgery via transforaminal approach. 2 patients with LDH in different side underwent FELD surgery via combined transforaminal and interlaminar approach. There were no immediate perioperative complications. The visual analog scale (VAS) decreased significantly in both early and late follow-up evaluations and these score demonstrated significant improvement in late follow-up (P < 0.01). For the modified MacNab criteria, the final outcome results were excellent in 9 patients (81.8%), good in 1 patients (0.9%), fair in1 patients (0.9%), and the overall success rate was 90.9%. Conclusion One-stage full-endoscopic lumbar discectomy for 2 level symptomatic ALDH is an effective and less invasive method, which can be considered as an alternative good technique for selected adolescent patients.

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When is the appropriate time for surgical intervention of the herniated lumbar disc in the adolescent?

Cited by 17 publications

References 18 publications

Scoliotic posture as the initial symptom in adolescents with lumbar disc herniation: its curve pattern and natural history after lumbar discectomy

Scoliotic posture as the initial symptom in adolescents with lumbar disc herniation: its curve pattern and natural history after lumbar discectomy

Review for the generalist: evaluation of low back pain in children and adolescents

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

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