Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>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/m<jats:sup>2</jats:sup>. 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).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>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.</jats:p></jats:sec>

Lumbar disc herniation surgery in adolescents and young adults

“…The symptoms in adolescents are similar to the ones seen in adults; 65-100% of the adolescents who undergo surgery for lumbar disc herniation present with low back pain and 41-100% experience sciatica (35)(36)(37)(38)(39)(40)(41). Other symptoms include neurogenic claudication (37-40%), motor deficit (4-26%) and sensory deficit (8-31%) (35)(36)(37)(38)(39)(40).…”

“…When examining adolescents, the most common findings are; positive straight-leg raise test (41-99%), paravertebral spasm and/or non-structural scoliosis (10-82%), motor deficit (19-60%), sensory deficit (6-59%), tenderness in the lower back (31-53%) and loss of deep tendon reflexes (12-33%) (35)(36)(37)(38)(39)(40)(41). Scoliosis in conjunction with lumbar disc herniation most often disappears after treatment and is often a reaction to the pain and/or muscle spasm (39).…”

“…Cauda equina syndrome is a rare disorder that can evolve due to a lumbar disc herniation, and it accounts for approximately 1-2% of all lumbar disc herniation surgeries (48,49). Cauda equina syndrome is rarely reported in studies of adolescent lumbar disc herniation, but one larger study reported that 2 out of 199 (1%) of the adolescents undergoing surgery had cauda equina syndrome (41). The syndrome occurs when the cauda equina (bundle of spinal nerves and spinal nerve rootlets located in the lumbar spine) is compressed and it can cause several symptoms including sciatica (most often bilateral), sensory deficits in the saddle region (including genitalia) and deficits in the bladder, bowel and sexual function (48).…”

Lumbar disc herniation in a 15-year-old girl: A case report

“…This initial misdiagnosis is a reflection of the low prevalence of LDH in children and the frequent exclusion of radiculopathy from the initial differential diagnosis of leg pain [15] . Patients should undergo herniated disc surgery if they have neurological deficits or unremitting pain [16] . Spinal fusion is not recommended for children, thus a minimally invasive approach should be chosen to avoid complications of spinal growth in children [3] , [15] .…”

Minimally invasive high-definition microscope assisted small channel treatment of lumbar disc herniation in children: a case report

“…In this case, the main manifestation of the child was discogenic pain caused by nerve root compression, and there were left limb weakness and progressive aggravation of symptoms. At present, there are few reports and insu cient understanding of LDH in children in China, and it is often misdiagnosed as lumbar sprain and rheumatic myocarditis in children [13] . Since the application of computed tomography (CT) and MRI imaging examinations, the accuracy of diagnosis has been improved.…”