Adolescent lumbar disc herniation: Experience from a large minimally invasive treatment centre for lumbar degenerative disease in Chongqing, China

Purpose: This article discusses the aetiology, medical history, physical examination, imaging characteristics and treatment modalities relevant to this entity aiming to increase awareness among paediatricians regarding LDH (lumbar disc herniation) in young children. Methods: We retrospectively reviewed the medical records of 120 adolescent patients (aged 13-20 years old) with LDH at the orthopaedics department of a teaching hospital in Chongqing, China, between 2001 and 2011. Results: The present retrospective analysis was performed on 121 adolescent patients (2.6%, 121/4695 cases with LDH operations) with LDH. One hundred and thirteen patients (93.4%) presented with low back pain with or without radiculopathy, and 12 patients (9.9%) presented with leg pain as the first symptom. Only 60 patients (49.6%) were diagnosed with LDH as their first outpatient diagnosis. Thirty-eight patients (31.4%) had a history of trauma before the onset of their symptoms. The most common segments were L4/5 (61, 50.4%), L5/S1 (42, 34.7%) and L4/5 + L5/S1 (13, 10.7%). Disc herniation was centrolateral in 77.7% (n = 94) and central in 35.5% (n = 43). Eighty patients were treated by MED (microendoscopy discectomy), 25 by PELD (percutaneous endoscopic lumbar discectomy) and 16 by OLD (open lumbar discectomy). The rate of operative complications was 3.8%, 4.0% and 6.3% in MED, PELD and OLD, respectively. Through the ordinal regression analysis, we found that the patients with central disc herniation had much better outcomes than the patients with centrolateral disc herniation (P = 0.046). Conclusions: Diagnosis of LDH in young children is usually delayed, but there were no risk factors for the delayed outpatient diagnosis of LDH. Awareness of LDH will help the paediatrician extract a relevant medical history, perform a directed physical examination and order appropriate imaging studies. (C) 2013 Elsevier B.V. All rights reserved.