title: Surgical treatments for lumbar disc disease in adolescent patients; chemonucleolysis / microsurgical discectomy/ PLIF with cages.
abstract: The herniated lumbar disc (HLD) in adolescent patients is characterized by typical discogenic pain that originates from a soft herniated disc. It is frequently related to back trauma, and sometimes it is also combined with a degenerative process and a bony spur such as posterior Schmorl's node. Chemonucleolysis is an excellent minimally invasive treatment having these criteria: leg pain rather than back pain, severe limitation on the straight leg raising test (SLRT), and soft disc protrusion on computed tomography (CT). Microsurgical discectomy is useful in the cases of extruded or sequestered HLD and lateral recess stenosis due to bony spur because the nerve root is not decompressed with chymopapain. Spinal fusion, like as PLIF, should be considered in the cases of severe disc degeneration, instability, and stenosis due to posterior central bony spur. In our study, 185 adolescent patients, whose follow-up period was more than 1 year (the range was 1-4 years), underwent spinal surgery due to HLD from March, 1998 to December, 2002 at our institute. Among these cases, we performed chemonucleolysis in 65 cases, microsurgical discectomy in 94 cases, and posterior lumbar interbody fusion (PLIF) with cages in 33 cases including 7 reoperation cases. The clinical success rate was 91% for chemonucleolysis, 95% for microsurgical disectomy, and 89% for PLIF with cages, and there were no non- union cases for the PLIF patients with cages. In adolescent HLD, chemonucleolysis was the 1st choice of treatment because the soft adolescent HLD was effectively treated with chemonucleolysis, especially when the patient satisfied the chemonucleolysis indications.
authors.affiliation: Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea. kuhsu@yumc.yonsei.ac.kr.
authors.forename: Sung-Uk
authors.initials: SU
authors.lastname: Kuh
authors.forename: Young-Soo
authors.initials: YS
authors.lastname: Kim
authors.forename: Young-Eun
authors.initials: YE
authors.lastname: Cho
authors.forename: Young-Sul
authors.initials: YS
authors.lastname: Yoon
authors.forename: Byung-Ho
authors.initials: BH
authors.lastname: Jin
authors.forename: Keun-Su
authors.initials: KS
authors.lastname: Kim
authors.forename: Dong-Kyu
authors.initials: DK
authors.lastname: Chin
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D017586:Diskectomy / Q000295:instrumentation / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007404:Intervertebral Disc Chemolysis; D007405:Intervertebral Disc Displacement / Q000601:surgery* / Q000628:therapy*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008866:Microsurgery; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome
references.citation: Spine (Phila Pa 1976). 1996 Feb 1;21(3):372-7
references.pmid: 8742215
references.citation: J Bone Joint Surg Am. 1985 Dec;67(9):1402-4
references.pmid: 4077911
references.citation: Acta Neurochir (Wien). 2000;142(10):1107-10
references.pmid: 11129531
references.citation: Spine (Phila Pa 1976). 1997 Sep 1;22(17):2044-9
references.pmid: 9306537
references.citation: J Pediatr Orthop. 1983 May;3(2):202-6
references.pmid: 6863525
references.citation: Spine (Phila Pa 1976). 1988 Sep;13(9):972-81
references.pmid: 3206304
references.citation: Childs Nerv Syst. 1998 Mar;14(3):131-4
references.pmid: 9579870
references.citation: J Neurosurg. 1989 Jun;70(6):869-75
references.pmid: 2654335
references.citation: Spine (Phila Pa 1976). 1984 May-Jun;9(4):427-32
references.pmid: 6474257
references.citation: Spine (Phila Pa 1976). 1995 Sep 15;20(18):2016-22
references.pmid: 8578379
references.citation: Neurosurgery. 2002 Nov;51(5 Suppl):S123-8
references.pmid: 12234439
references.citation: Spine (Phila Pa 1976). 2001 Sep 15;26(18):1997-2000
references.pmid: 11547199