Lumbar Disc Excisions in Children and Adolescents

Patrizio Parisini, MD,
Tiziana Greggi, MD,
Mario Di Silvestre, MD,
Stefania Paderni, MD
Bologna, Italy

PURPOSE:
The present study was undertaken to investigate long–term results and effectiveness of surgical management for lumbar intervertebral disc herniation in children younger than 18 years of age.

MATERIAL AND METHODS:
Between 1975 and 1991, a total of 5160 patients underwent surgery for lumbar intervertebral disc herniation at our institution. We detected 129 cases (2.5%) younger than 18 years of age. 84 were boys and 45 were girls. The average age at surgery was 16.2 yrs (range, 9 to 18 years), only 3 subjects were aged 9, 11 and 12 years, respectively, in 60 cases age was between 13 and 16 years and in 66 between 17 and 18 years. Low back pain associated with leg pain was the main clinical symptom in 106 patients (82%), only low back pain in 17 (13%) and only leg pain in 6 (5%). We detected associated structural abnormalities in 40 cases: 14 lumbar Scheuermann–type changes, 9 spina bifida occulta, 4 lumbosacral transitional anomalies, 5 displaced ring apophysis, 3 spondylolisthesis (L5–S1), 2 thoracic scoliosis, 2 idiopathic lumbar stenosis and 1 previous compression fracture of the L4 body. Posterior discectomy by conventional procedure without fusion was performed in all patients, and 3 cases with associated spondylolisthesis underwent posterolateral arthrodesis, supplemented in 2 by pedicle screw synthesis. Patients were followed in a short–term assessment using medical records. Long–term follow–up was done by a mailed, self–report questionnaire that quantified leg and back pain, and scored ability to return to normal activities and satisfaction. All non–responders whose residence was traceable were contacted by telephone.

RESULTS:
Short–term results were excellent for 120 patients (93%) and postoperative complications included one superficial wound infection and one discitis. A total of 98 (76%) long–term responses were obtained with a mean follow–up time of 12.4 years (range, 6–19.4 years). Mean age at long–term follow–up was 28.7 years. Long–term follow–up yielded the following outcomes: excellent 56%, good 30%, poor 14%. 8 patients (6.2%) required additional surgical treatment at a mean interval from the first surgery of 9 Years (range, 2 to 16): 3 of them had a re–exploration for a herniated disc at the same level, 5 at a different level.

CONCLUSIONS:
Our results have confirmed a tendency for outcomes to deteriorate between the short term and long term follow–ups in young patients, as well as in adults, treated by discectomv. Furthermore they have suggested that people at the greatest risk of experiencing herniation of intervertebral discs are younger individuals with lumbar Scheuermann–type changes (10% in our series). Finally, almost uniformly good results indicate that discectomy for young patients should be delayed by conservative therapy no more than for older patients.