Lumbar microdiscectomy in pediatric patients: a large single-institution series.
OBJECTIVE
Lumbar disc herniation is a rare but significant cause of pain and disability in the pediatric population. Lumbar microdiscectomy, although routinely performed in adults, has not been described in the pediatric population. The objective of this study was to determine the surgical results of lumbar microdiscectomy in the pediatric population by analyzing the experiences at Children's Hospital Boston over the past decade.


METHODS
A series of 87 consecutive cases of lumbar microdiscectomy performed by the senior author (M.R.P.) from 1999 to 2008 were reviewed. Presenting symptoms, physical examination findings, and preoperative MR imaging findings were obtained from medical records. Immediate operative results were assessed including operative duration, blood loss, length of stay, and complications, along with long-term outcome and need for repeat surgery.


RESULTS
This series represents the first surgical series of pediatric microdiscectomies. The mean patient age was 16.6 years (range 12-18 years) and 60% were female. The preoperative physical examination results were notable for motor deficits in 26% of patients, sensory changes in 41%, loss of deep tendon reflex in 22%, and a positive straight leg raise in 95%. Conservative management was the first line of treatment in all patients and the mean duration of symptoms until surgical treatment was 12.2 months. The mean operative time was 110 minutes and the mean postoperative length of stay was 1.3 days. Complications were rare: postoperative infection occurred in 1%, postoperative CSF leak in 1%, and new postoperative neurological deficits in 1%. Only 6% of patients needed repeat lumbar surgery and 1 patient ultimately required lumbar fusion.


CONCLUSIONS
The treatment of pediatric lumbar disc herniation with microdiscectomy is a safe procedure with low operative complications. Nuances of the presentation, treatment options, and surgery in the pediatric population are discussed.
Cahill
Kevin S
KS
Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Dunn
Ian
I
Gunnarsson
Thorsteinn
T
Proctor
Mark R
MR
D000293:Adolescent; D002648:Child; D017586:Diskectomy / Q000009:adverse effects / Q000379:methods*; D020820:Dyskinesias / Q000209:etiology / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000473:pathology / Q000601:surgery*; D007902:Length of Stay; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods*; D009460:Neurologic Examination; D010468:Perceptual Disorders / Q000209:etiology / Q000473:pathology / Q000601:surgery; D012021:Reflex, Abnormal; D012189:Retrospective Studies; D013123:Spinal Fusion; D013997:Time Factors; D016896:Treatment Outcome