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Published on: August 7, 2018
Pediatric lumbar disc surgery: 20 patients under 15 years of age
1Children's Hospital, Harvard Medical School, Cambridge, Massachusetts, USA.
Insights
Pediatric lumbar disc disease often presents without sciatica and may require surgery. Lumbar discectomy in children under 15 is safe and successful in 88% of cases.
Area of Science:
- Pediatric Orthopedics
- Neurosurgery
- Spinal Surgery
Background:
- Central lumbar disc protrusion can occur in adolescents presenting with back pain, even without sciatica or painless scoliosis.
- This condition in the first two decades of life may be overlooked due to atypical symptoms.
- Conservative treatment for up to two years has often failed in diagnosed cases.
Purpose of the Study:
- To determine the differences in symptomatology, surgical findings, and outcomes between pediatric and adult lumbar disc disease.
- To evaluate the efficacy and safety of lumbar discectomy in patients under 20 years old.
Main Methods:
- A retrospective review of 60 patients under 20 who underwent lumbar discectomy between 1958 and 1995.
- Focus on a subgroup of 20 patients under 15 years old, with follow-up up to 20 years.
- Analysis of clinical presentation, surgical details, imaging (including computed tomography scans), and long-term outcomes.
Main Results:
- Sciatica was initially present in only 20% of patients, rising to 60% by surgery.
- The L5-S1 disc was affected in 75%, with central protrusion in 75% and ossification of the posterior spinal ligament in 40%.
- Significant antecedent trauma was noted in 45%, and a family history of disc disease in 60%.
Conclusions:
- Lumbar disc disease in young patients can be missed due to the absence of sciatica.
- Lumbar discectomy in children under 15 years of age demonstrated a safe profile.
- The study reported an 88% success rate for lumbar discectomy in this pediatric cohort.
Background:
Patients in their first or second decades of life who present with back pain without sciatica or painless scoliosis have been found to have a central lumbar disc protrusion. This study was elected to determine the difference between pediatric and adult disc symptomatology, surgical findings, and the results of surgery.
Methods:
Review of office and Children's Hospital records from 1958 through 1995 yielded a total of 60 patients under the age of 20 years who had lumbar discectomy by the author. Twenty were under the age of 15. This group is reported herein. All but 3 have been followed for up to 20 years. RESULTS The youngest was a boy 10 years and 8 months at operation. Only 20% complained initially of sciatic pain; 60% had it by the time of surgery; 20% never had it. The offending disc was at L5-S1 in 75%. The disc protrusion was central in 75%; no disc had ruptured. The posterior spinal ligament had ossified in the protruded position in 40%. Computed tomography (CT) scans were particularly useful. Significant antecedent trauma was present in 45%. Sixty percent were males. There was a family history of disc disease in 60%. The whereabouts of 3 of the 20 patients is unknown; their operations were 20-36 years ago.
Conclusions:
Lumbar disc disease in the first 2 decades may be missed because of the absence of sciatica. Once diagnosed, conservative therapy for as long as 2 years has failed. Lumbar discectomy in children under 15 years was safe in all cases and known to be successful in 88%.
