Lumbar microdiscectomy in pediatric patients: a large single-institution series

Cahill, Kevin S.; Dunn, Ian F.; Gunnarsson, Þorsteinn; Proctor, Mark R.

doi:10.3171/2009.9.spine09756

Cited by 53 publications

(50 citation statements)

References 21 publications

(32 reference statements)

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“…There have been only a few studies on lumbar disc herniation in children and adolescents, and all are retrospective [8][9][10][11][12][13][14][15][16]. The indications for surgical treatment of lumbar disc herniation in adolescents are generally no improvement of severe pain with conservative treatment, disabling pain that affects daily activities, cauda equina syndrome, or progressive neurologic deficits [17].…”

Section: Introductionmentioning

confidence: 98%

An observational study on the outcome after surgery for lumbar disc herniation in adolescents compared with adults based on the Swedish Spine Register

et al. 2015

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Section: Introductionmentioning

confidence: 98%

An observational study on the outcome after surgery for lumbar disc herniation in adolescents compared with adults based on the Swedish Spine Register

et al. 2015

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“…34 Complications related to lumbar microdiscectomy are typically analyzed from an institutional or individual surgeon perspective. 4,5,31 A systematic review and metaanalysis of complications following the various surgical techniques to perform lumbar microdiscectomy has not been previously performed. Accurate knowledge of complication rates following conventional open, MED, and percutaneous approaches can be used to help educate patients and surgeons during the informed consent process.…”

mentioning

confidence: 99%

Lumbar microdiscectomy complication rates: a systematic review and meta-analysis

Shriver¹,

Xie

Tye³

et al. 2015

FOC

126

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OBJECT Lumbar microdiscectomy and its various minimally invasive surgical techniques are seeing increasing popularity, but a systematic review of their associated complications has yet to be performed. The authors sought to identify all prospective clinical studies reporting complications associated with lumbar open microdiscectomy, microendoscopic discectomy (MED), and percutaneous microdiscectomy. METHODS The authors conducted MEDLINE, Scopus, Web of Science, and Embase database searches for randomized controlled trials and prospective cohort studies reporting complications associated with open, microendoscopic, or percutaneous lumbar microdiscectomy. Studies with fewer than 10 patients and published before 1990 were excluded. Overall and interstudy median complication rates were calculated for each surgical technique. The authors also performed a meta-analysis of the reported complications to assess statistical significance across the various surgical techniques. RESULTS Of 9504 articles retrieved from the databases, 42 met inclusion criteria. Most studies screened were retrospective case series, limiting the number of studies that could be included. A total of 9 complication types were identified in the included studies, and these were analyzed across each of the surgical techniques. The rates of any complication across the included studies were 12.5%, 13.3%, and 10.8% for open, MED, and percutaneous microdiscectomy, respectively. New or worsening neurological deficit arose in 1.3%, 3.0%, and 1.6% of patients, while direct nerve root injury occurred at rates of 2.6%, 0.9%, and 1.1%, respectively. Hematoma was reported at rates of 0.5%, 1.2%, and 0.6%, respectively. Wound complications (infection, dehiscence, orseroma) occurred at rates of 2.1%, 1.2%, and 0.5%, respectively. The rates of recurrent disc complications were 4.4%, 3.1%, and 3.9%, while reoperation was indicated in 7.1%, 3.7%, and 10.2% of operations, respectively. Meta-analysis calculations revealed a statistically significant higher rate of intraoperative nerve root injury following percutaneous procedures relative to MED. No other significant differences were found. CONCLUSIONS This review highlights complication rates among various microdiscectomy techniques, which likely reflect real-world practice and conceptualization of complications among physicians. This investigation sets the framework for further discussions regarding microdiscectomy options and their associated complications during the informed consent process.

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“…Pediatric LDH is rare, and although this patient population tends to respond less to conservative management, 8,15 many patients do respond and are never seen by a spine specialist. 2 Thus, it is generally agreed that in the absence of neurological deficits or intractable pain, conservative therapy should be attempted prior to the consideration of surgical options. In our study, all patients were managed conservatively for at least 4 months unless the degree of weakness prompted more urgent surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

Tubular approach to minimally invasive microdiscectomy for pediatric lumbar disc herniation

Montejo¹,

Camara-Quintana²,

Durán³

et al. 2018

Journal of Neurosurgery: Pediatrics

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OBJECTIVELumbar disc herniation (LDH) in the pediatric population is rare and exhibits unique characteristics compared with adult LDH. There are limited data regarding the safety and efficacy of minimally invasive surgery (MIS) using tubular retractors in pediatric patients with LDH. Here, the outcomes of MIS tubular microdiscectomy for the treatment of pediatric LDH are evaluated.METHODSTwelve consecutive pediatric patients with LDH were treated with MIS tubular microdiscectomy at the authors’ institution between July 2011 and October 2015. Data were gathered from retrospective chart review and from mail or electronic questionnaires. The Macnab criteria and the Oswestry Disability Index (ODI) were used for outcome measurements.RESULTSThe mean age at surgery was 17 ± 1.6 years (range 13–19 years). Seven patients were female (58%). Prior to surgical intervention, 100% of patients underwent conservative treatment, and 50% had epidural steroid injections. Preoperative low-back and leg pain, positive straight leg raise, and myotomal leg weakness were noted in 100%, 83%, and 67% of patients, respectively. The median duration of symptoms prior to surgery was 9 months (range 1–36 months). The LDH level was L5–S1 in 75% of patients and L4–5 in 25%. The mean ± SD operative time was 90 ± 21 minutes, the estimated blood loss was ≤ 25 ml in 92% of patients (maximum 50 ml), and no intraoperative or postoperative complications were noted at 30 days. The median hospital length of stay was 1 day (range 0–3 days). The median follow-up duration was 2.2 years (range 0–5.8 years). One patient experienced reherniation at 18 months after the initial operation and required a second same-level MIS tubular microdiscectomy to achieve resolution of symptoms. Of the 11 patients seen for follow-up, 10 patients (91%) reported excellent or good satisfaction according to the Macnab criteria at the last follow-up. Only 1 patient reported a fair level of satisfaction by using the same criteria. Seven patients completed an ODI evaluation at the last follow-up. For these 7 patients, the mean ODI low-back pain score was 19.7% (SEM 2.8%).CONCLUSIONSTo the authors’ knowledge, this is the longest outcomes study and the largest series of pediatric patients with LDH who were treated with MIS microdiscectomy using tubular retractors. These data suggest that MIS tubular microdiscectomy is safe and efficacious for pediatric LDH. Larger prospective cohort studies with longer follow-up are needed to better evaluate the long-term efficacy of MIS tubular microdiscectomy versus other open and MIS techniques for the treatment of pediatric LDH.

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Lumbar microdiscectomy in pediatric patients: a large single-institution series

Abstract: The treatment of pediatric lumbar disc herniation with microdiscectomy is a safe procedure with low operative complications. Nuances of the presentation, treatment options, and surgery in the pediatric population are discussed.

Cited by 53 publications

References 21 publications

An observational study on the outcome after surgery for lumbar disc herniation in adolescents compared with adults based on the Swedish Spine Register

An observational study on the outcome after surgery for lumbar disc herniation in adolescents compared with adults based on the Swedish Spine Register

Lumbar microdiscectomy complication rates: a systematic review and meta-analysis

Tubular approach to minimally invasive microdiscectomy for pediatric lumbar disc herniation

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