Adolescent lumbar disc herniation: etiology, diagnosis, and treatment options

Adolescent lumbar disc herniation (ALDH) is a type of disease with a much lower incidence than adult lumbar disc herniation (LDH), which has a trend of increasing year by year. If the diagnosis is not timely or the treatment is not appropriate, it will have a serious impact on the adolescent's psychology. The etiology of ALDH remains unclear, and it is thought that trauma, genetic, immunity, developmental abnormalities, and biomechanical abnormalities contribute to the onset and accelerate ALDH's progression. The diagnosis of ALDH is similar to that of adults, but it has its characteristics, such as a positive straight leg raising (SLR) test in nearly 90% of patients, and posterior apophyseal ring fracture (PARF) is considered a characteristic imaging finding of ALDH. First-line treatment for ALDH remains conservative, although it is less effective than in adults. With the development of regenerative medicine, more and more treatment methods for small traumas have been applied to ALDH and achieved satisfactory treatment results. In the case of the above treatment, the effect is not satisfactory, surgery has become the last choice, different from the earliest use of open discectomy combined with fusion surgery, now more and more surgeries tend to use spinal endoscopic operation to solve, especially patients combined with some high-risk factors, and achieved satisfactory results. With the deepening of ALDH research, the etiology and mechanism of ALDH may be more fully understood. At the same time, with the development of Artificial intelligence (AI) technology, it is believed that in the near future, AI can provide references in the timing of conservative treatment for ALDH, the selection of surgical modalities, and the prediction of postoperative complications.