Lumbar Disc Herniation in Adolescents. Clinical Experience and Surgical Outcome

Background: Lumbar disc herniations in adolescence are a relatively rare conditionreported to occur in less than 3% of those presenting with low back pain. The clinicalpresentations of adolescent disc herniation differ from those of the adults. Back pain isnot all marked in adolescent patients. Persistent postural disturbances and lack ofhistory of injury are the prevalent presentations. Objective: this study was subjected todiscuss the etiology, diagnosis and treatment modalities of lumbar disc herniation inadolescents. Patients and Methods: During the period from September 2011 to August2013, twenty five patients between 13 and 19 years old (teenage years) underwentlumbar discectomy in the Neurosurgery Department, Al-Menoufia University with followup period up to 12 months post-operative. Results: twenty patients (80%) presented withlow back pain with or without radiculopathy, and fifteen patients (60%) presented withsciatic pain as the first symptom. The most common levels affected were L4/5 in fourteenpatients (56%), L5/S1 in eight patients (32%) and L4/5 + L5/S1 in three patients (12%).Surgical modalities were microdiscectomy in fifteen patients (60%), open discectomy insix patients (24%) and percutaneous endoscopic discectomy in four patients (16%).Post-operative complications were persistent back pain in three cases (12%), transientcerebrospinal fluid (CSF) leakage in two cases (8%) and wound infection in one case(4%). Conclusion: Disc herniation in the adolescent is a rare cause of low back pain.The natural history is not known. Conservative treatment is the mainstream care. Goodselection and meticulous surgical procedures give satisfactory outcome.