Intervertebral disc herniation in adolescents.
BACKGROUND
The purpose of this study was to review surgery-proven lumbar disc herniation in adolescents with an emphasis on the distinguishing features.


METHODS
Twenty-eight adolescents between 14 and 18 years old had lumbar discectomy after conservative treatment for 9 months. Indications for surgery were intractable pain and failure of conservative treatment for more than 6 weeks. Lumbar spine apophyseal ring fracture was found in 10 of the 24 patients (42%) who had computed tomography studies. Seven patients had piecemeal excision of the fractured apophysis together with the discectomy.


RESULTS
All but three patients could raise their leg more than 70 degrees after the operation. The latest follow-up was conducted an average of 6.1 years after surgery. Good or excellent results were noted in 93% of the patients. Two patients had follow-up operations for recurrent disc herniation and wound infection.


CONCLUSIONS
Apophyseal ring fracture was a feature in adolescent disc herniation that requires surgical intervention. Early computed tomography study is proposed to detect apophyseal ring lesion, which may lead to failure of conservative treatment. Excision of the fractured ring apophysis is suggested in addition to discectomy when the canal space is occupied.
Chen
Lih-Huei
LH
Department of Orthopedics, Department of Radiology, Chang Gung Memorial Hospital, Taipei. lhchen2132@cgmh.org.tw
Chang
Chia-Hsieh
CH
Lee
Zhon-Liau
ZL
Niu
Chi-Chien
CC
Lai
Po-Liang
PL
Tan
Chih-Feng
CF
Chen
Wen-Jer
WJ
D000293:Adolescent; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000175:diagnosis / Q000601:surgery; D008297:Male