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Intervertebral disc herniation in adolescents.

Lih-Huei Chen1, Chia-Hsieh Chang, Zhon-Liau Lee

  • 1Department of Orthopedics, Department of Radiology, Chang Gung Memorial Hospital, Taipei. lhchen2132@cgmh.org.tw

Chang Gung Medical Journal
|April 13, 2004
PubMed
Summary

Adolescent lumbar disc herniation often involves apophyseal ring fractures, necessitating surgical intervention. Early CT scans can detect these fractures, improving treatment outcomes for pediatric spinal conditions.

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Area of Science:

  • Orthopedic Surgery
  • Pediatric Spine Surgery
  • Spinal Imaging

Background:

  • Adolescent lumbar disc herniation presents unique challenges compared to adult cases.
  • Distinguishing features of pediatric disc herniation require specific diagnostic and treatment considerations.

Purpose of the Study:

  • To review surgery-proven lumbar disc herniation in adolescents.
  • To emphasize the distinguishing features of adolescent lumbar disc herniation.

Main Methods:

  • Retrospective review of 28 adolescents (14-18 years) undergoing lumbar discectomy.
  • Conservative treatment failure (6+ weeks) and intractable pain were surgical indications.
  • Computed tomography (CT) identified lumbar spine apophyseal ring fractures in 42% of patients.

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Main Results:

  • 93% of patients achieved good or excellent outcomes at an average 6.1-year follow-up.
  • Post-operative leg raise improved significantly (>70 degrees) in most patients.
  • Two patients required reoperation for recurrent disc herniation and wound infection.

Conclusions:

  • Apophyseal ring fracture is a key feature in adolescent disc herniation requiring surgery.
  • Early CT imaging is recommended to detect apophyseal ring lesions.
  • Excision of fractured apophysis during discectomy may be necessary when the canal is compromised.