Surgical management of lumbar disc herniation in children and adolescents

Lumbar disc herniation (LDH) is a rare cause of morbidity in the paediatric population that can result in disruption to education and participation in social and athletic activities. Modern minimally invasive techniques have increasingly been adopted in paediatric spine surgery. The purpose of this review was to assess characteristics of paediatric LDH, evaluate current surgical techniques and their outcomes in recent literature, and compare paediatric outcomes with adults. A literature search was carried out identifying articles published from 2008 to 2018 relating to surgical treatment of LDH in children and adolescents. Original articles were scrutinised for outcome data and complications then compared by surgical approach. Over the last decade 1094 surgical cases have been published, mostly L4/L5 (52%) and L5/S1 (41%) intervertebral discs. These were predominantly operated with microdiscectomy and minimally invasive techniques: percutaneous endoscopic and tubular approaches to discectomy. Cystic fibrosis, trauma, extensive athletic activity, facet joint asymmetries and lumbosacral transition vertebrae may be risk factors for LDH. 55% had total resolution of pain after surgery, complications are rare and unsatisfactory resolution of pain and re-operation uncommon. In the short and medium-term, overall, paediatric patients do not have worse surgical outcomes than adult patients; they may recover faster and improve more. Minimally invasive approaches for LDH in adolescents are safe and efficacious. No technique has yet demonstrated clear superiority. Delaying surgery for conservative treatment is warranted, but for how long remains unclear.