Adolescent lumbar disc herniation and hamstring tightness - Review of 16 cases

Study Design. Retrospective review. Objectives. To investigate the clinical characteristics and responses to surgical and conservative treatments of lumbar disc herniation in adolescents with hamstring tightness. Summary of Background Data. The incidence of hamstring tightness in adolescent lumbar disc herniation is much higher than that of adults. Hamstring tightness has been reported to result from nerve root or cauda equina irritation. But the clinical characteristics, prognosis, and etiologic mechanism of hamstring tightness has not been clearly investigated. Methods. Sixteen consecutive adolescents ( age range, 12 - 18 years; mean, 15.8 years) with lumbar disc herniation were analyzed. Among them, there were 10 cases with hamstring tightness. Clinical and radiologic findings of the study group were compared with those of the remaining 6 cases. After conservative treatment, 5 cases in the hamstring tightness group were treated with discectomy, and of these, 1 case was treated with shortening osteotomy in the upper part of the bilateral femurs 10 months after the discectomy because of the persisting hamstring tightness. Another 5 discectomies were done in the nonhamstring tightness group. All patients were observed for a mean of 2.7 years ( range, 0.8 - 6 years). Results. In all patients, the neurologic defects were improved shortly after the treatment, but the hamstring tightness continued and remained even after 1 year. The patient who underwent femoral osteotomy showed improvement. Conclusions. The incidence of hamstring tightness in adolescent lumbar disc herniation is high. The physical examination findings and prognoses of patients with hamstring tightness are different from those of simple disc herniation patients. The hamstring tightness appeared to have developed from a different mechanism.