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Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series
Malia McAvoy1,2, Heather J McCrea3, Vamsidhar Chavakula4
11Division of Health Sciences and Technology, Harvard Medical School, Boston, Massachusetts.
Insights
Lumbar microdiscectomy (LMD) offers safe and effective long-term pain relief and return to activities for pediatric patients with lumbar disc disease. This study highlights positive outcomes and low complication rates following LMD in adolescents.
Area of Science:
- Neurosurgery
- Pediatric Orthopedics
- Spinal Surgery
Background:
- Pediatric lumbar disc herniation is rare, limiting studies on long-term outcomes after lumbar microdiscectomy (LMD).
- Understanding risk factors, presentation, and functional outcomes is crucial for this population.
Purpose of the Study:
- To analyze risk factors, clinical presentation, complications, and long-term functional outcomes of pediatric patients undergoing LMD.
- To evaluate the safety and efficacy of LMD in adolescents with symptomatic lumbar disc disease.
Main Methods:
- Retrospective case series of 199 pediatric patients (12-18 years) undergoing LMD from 1998-2017.
- Analysis of premorbid factors, conservative management, surgical indications, complications, and postoperative outcomes.
- Long-term follow-up (mean 8.2 years) assessing reoperation rates and return to activities.
Main Results:
- Most patients (98%) failed conservative management; 70.9% participated in competitive sports.
- Low complication rates: 2.0% CSF leak, 1.5% wound infection.
- High success rate: 93.3% reported minimal pain postoperatively, mean return to sports 9.8 weeks, 7.5% reoperation rate.
Conclusions:
- Lumbar microdiscectomy is a safe and effective treatment for pediatric patients with symptomatic lumbar disc disease.
- It provides long-term pain relief and facilitates return to daily activities and sports after conservative management failure.
- The procedure demonstrates favorable long-term functional outcomes with manageable complication rates.
Objective:
Few studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.
Methods:
A retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.
Results:
Over the 19-year study period, 199 patients underwent LMD at the authors' institution. The mean age at presentation was 16.0 years (range 12-18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).
Conclusions:
Microdiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.
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