Intervertebral disc impingement syndrome in a child. Report of a case and suggested pathology

Nerve root impingement syndrome is rare in children and adolescents. The symptomatology of the pediatric group sometimes differs from that of the adult. An accurate diagnosis is often delayed because of concerns for neoplasm, infection, and spondylolisthesis. A case report of an 11-year-old boy with symptoms and myelographic findings consistent with a herniated disc is presented. A review of the literature disclosed only four cases of herniated disc in children under the age of 12 years. Our case represents one of the youngest patients with documented intervertebral disc impingement syndrome. Rather than a herniation due to degenerative changes in the annulus, a slipping of the entire disc, and vertebral end-plate (a "slipped vertebral apophysis") may precipitate a central disc impingement in children and adolescents. This has been reported in cases of trauma previously. However, the authors think that this slipped vertebral apophysis may, in fact, represent a large number of the so-called herniated discs in adolescents. It is also suggested that this may be an identifiable syndrome with a susceptible age range, activity level and body habitus.