Lumbar disc herniation in a 27-month-old child. Case report.
The occurrence of disc herniation is rare in children. A 27-month-old child fell from his cradle and developed, in the following 2 weeks, irritability, low-back pain, and difficulty in walking. On physical examination a compensatory gait, paravertebral muscle spasm, and a restricted right straight-leg raising test were demonstrated. Plain x-ray films revealed a narrowed L4-5 intervertebral space. Magnetic resonance imaging of the lumbosacral spine demonstrated decreased signal in the L4-5 disc, with posterior disc protrusion. At surgery, blood infiltrating the subperiosteal plane was observed. Via a left hemilaminectomy and under microscopic magnification, the left L-5 nerve root was found to be intact, and on the right side significant nerve root compression was identified. During dissection an accidental dural tear occurred. A right L-4 hemilaminectomy was performed, and the disc fragments were removed until a complete nerve root decompression was obtained and the dura was repaired. The child recovered uneventfully and was asymptomatic 7 years postsurgery. This child is one of the youngest patients with a herniated disc reported in the world literature. The authors discuss the diagnostic difficulties and management of this entity in children.
Revuelta
R
R
Department of Neurosurgery, Hospital Español de México, Deleg Miguel Hidalgo, USA. rogelio_revuelta@hotmail.com
De Juambelz
P P
PP
Fernandez
B
B
Flores
J A
JA
D000058:Accidental Falls; D000061:Accidents, Home; D001416:Back Pain / Q000209:etiology; D002675:Child, Preschool; D005684:Gait; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D007796:Laminectomy; D008159:Lumbar Vertebrae / Q000473:pathology* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D011843:Radiculopathy / Q000209:etiology / Q000601:surgery