Introduction: Lumbar disc herniations are an uncommon but significant cause of pain and disability among pediatric patients. We analyzed potential risk factors, clinical manifestations, management decisions, and surgical outcome of a large single-institution series of patients who underwent lumbar microdiscectomy over 15 years.
Methods: Retrospective chart review was conducted on all pediatric patients at Boston Children’s Hospital who underwent microdiscectomy for disc herniation. Pre-morbid risk factors, clinical presentation, exam findings, type and duration of conservative management, indication for surgical intervention, complications, and post-operative outcomes were examined. Patient involvement in competitive athletics was noted.
Results: Between 1999 and 2014, 165 patients underwent microdiscectomy at our institution. Average age at presentation was 16.5 years and 57.6% were female. Of these patients, 73.3% were considered athletes. The most common presentation was lower back and radicular leg pain. The most frequent exam finding was positive straight leg raise (96.4%), sensory abnormalities (34.5%), loss of deep tendon reflexes (20.6%), and typically subtle motor deficits (20.6%). Average time between onset of symptoms and surgery was 11.1 months; 99.4% had failed conservative management. The average length of stay was 1.3 days following surgery. Complications included rare CSF leak (1.8%), meningitis (0.6%), and one new neurological deficit (0.6%). On long-term follow up, 4% needed reoperation for the same level, and another 3% underwent adjacent level decompression. 1 patient required two operations at the same level, and subsequently required an L3-S1 fusion, to which he had an excellent response.
Conclusions: Microdiscetomy is an effective and safe treatment option for patients with symptomatic lumbar disc disease who have failed conservative management.
Patient Care: By demonstrating that pediatric microdiscectomy is a safe and effective management option for patients with lumbar disc herniation who fail conservative management.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Describe the presentation of lumbar disc herniation in the pediatric population;
2) Recognize lumbar microdiscectomy as a safe and effective treatment option in the pediatric population.