Pediatric Disk Herniation

Lavelle, William F.; Bianco, Aaron; Mason, Robert C.; Betz, Randal R.; Albanese, Stephen A.

doi:10.5435/00124635-201111000-00001

Cited by 48 publications

(55 citation statements)

References 33 publications

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“…To the best of our knowledge, there have been no further reports, thereby making our study the longest outcomes study and the largest. 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.…”

Section: Discussionmentioning

confidence: 99%

“…8,15 The approach to adult and pediatric LDH has historically included open laminectomy with discectomy, which is an approach that dates back to the mid-20th century. 17 More recently, minimally invasive surgery (MIS) techniques have grown in favor because of their ability to preserve important muscle attachments and avoid excessive bone removal, which may compromise spinal stability.…”

mentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

mentioning

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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“…The radicular symptoms are produced from compression of the traversing or exiting nerve roots by the herniated disc material. In general, pediatric herniations are most commonly paracentral [ 38 ]. The movements most inherent to the tennis stroke -rotation, fl exion, and axial compression -are also those that are most correlated with disc herniation.…”

Section: Disc Herniationmentioning

confidence: 99%

“…It has been shown, however, that younger patients do not do as well with conservative therapy [ 38 ]. Surgical options include open discectomy or microdiscectomy.…”

Section: Disc Herniationmentioning

confidence: 99%

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Spine Injuries in Tennis Players

McAnany

Patterson

Hecht

2016

Contemporary Pediatric and Adolescent Sports Medicine

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Musculoskeletal Low Back Pain in School-aged Children

2017

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ow back pain (LBP) in school-aged children is a common occurrence; nevertheless, it is often underappreciated. 1 The prevalence of LBP rises with age: 1% at age 7 years, 6% at age 10 years, and 18% at ages 14 to 16 years. 2 By age 18 years, the lifetime prevalence rates of LBP approach those documented in adults, with an estimated yearly prevalence of 20% and a lifetime prevalence of 75%. 3 More than 7% of adolescents experiencing LBP will seek medical attention. 1 The effect of LBP on this population can be considerable and may significantly restrict instrumental activities of daily living for this population, such as attendance at school and gym or sports participation. 4 Low back pain in this age group is a significant risk factor for developing LBP as an adult. 5 Several potential risk factors for developing LBP in schoolaged children have been investigated. The prevalence of LBP correlates with participation in sports and level of competition. 4,6,7 There is a U-shaped association between physical activity and the incidence of LBP in school-aged children, with both low and high levels of physical activity associated with a higher risk. 8,9 Female sex, growth acceleration, adverse psychosocial factors, increasing age, previous back injury, and family history of LBP are all potential risk factors for school-aged children to develop LBP. 9-12 Although there has been concern about a potential association of LBP and backpacks, the evidence pointing to use of backpacks as a risk factor is weak. 9 No single risk factor for a first episode of LBP in school-aged children has been definitively validated (level of evidence, 1). 13 Historically, it has been taught that most LBP in school-aged children has an identifiable diagnosis. More recent research has challenged this thinking. A high-quality prospective study of 73 pediatric patients with LBP (level of evidence, 2) followed up for 2 years found that nearly 80% had no definitive diagnosis. 14 Most cases of LBP in school-aged children are nonspecific and self-limiting. 15,16 Discussion and Observations Relevant AnatomyPediatricians need a basic but solid understanding of the anatomy of the lumbosacral spine to provide effective care to school-aged children with LBP. The lumbar spine is composed of 5 vertebrae IMPORTANCE Low back pain (LBP) in children and adolescents is a common problem. The differential diagnosis of LBP in this population is broad and different from that seen in the adult population. Most causes of LBP are musculoskeletal and benign in their clinical course. Clinicians should have an understanding of the relevant anatomy and the most commonly encountered etiologic factors of LBP in children and adolescents to provide effective care.OBSERVATIONS Low back pain is rarely seen in youth before they reach school age. Subsequently, rates of LBP rise until age 18 years, at which age the prevalence of LBP is similar to that in adults. The differential diagnosis of LBP in this population is broad, and individual etiologic factors are most often associated wit...

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Pediatric Disk Herniation

Cited by 48 publications

References 33 publications

Tubular approach to minimally invasive microdiscectomy for pediatric lumbar disc herniation

Tubular approach to minimally invasive microdiscectomy for pediatric lumbar disc herniation

Spine Injuries in Tennis Players

Musculoskeletal Low Back Pain in School-aged Children

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