Clinical Analysis of Herniated Lumbar Discs in Children

Oh, Seong Hoon; Kim, Young Soo

Abstract

Herniated lumbar disk occur rarely during childhood and infrequently during adolescence. Authors reviewed the radiographs and medical records of 33 consecutive patients(22 males and 11 females) younger than 17 years who underwent lumbar discectomy and chemonucleolysis between 1983 and 1988 at the Dept. of neurosurgery, Yongdong Severance Hospital, Yonsei University College of Medicine, The average length of follow-up was 8.8 month. The duration of symptoms before surgical intervention varied from weeks to 5 years and characterized by bimodal high incidence from 2 months to 6 months and over 1 year. Spine CT scan was a most important part of the radiographic evaluation. Trauma was not a significant etiologic factor. All of the patients(100%) had lower back pain with sciatica, while a positive Laseque's test and limited back motion were the most frequent objective findings. The clinical picture was similar to that in the adult. But objective findings dominate in children, and their complaints were minor. Then w e finded that a strongly positive stratight leg raising test, scoliosis and other prominent physical signs justify surgery, if effort at conservative therapy had been unrewarding. The disk operations were performed at the L4-5 level in 54.5% of patients, the L5-S1 level in 27.5%, the L3-4 and L4-5 level in 3%, the L4-5 and L5-S1 level in 15%, Twenty eight of the 33 patients underwent chemonucleolysis and five underuent partial hemilaminectomy with discectomy. After surgical treatment including chemonucleolysis in this group of patient, the results were excellent in 60.6%, good in 36.3%, and fair in only 3.1.