title: Lumbar Disk Herniation in Children and Adolescents: The Significance of Configurations of the Lumbar Spine.
abstract: BACKGROUND
  Lumbar disk herniation in adults is thought to be caused by repetitive overloading and age-rated degenerative changes. However, these causes are absent in children and adolescent patients. We assume that structural malformations in the lumbar spine could predispose intervertebral disks to early degeneration and hence need to be surgically fused. This issue has never been raised before.
  
  
  OBJECTIVE
  To investigate the assumption that structural malformations in the lumbar spine could predispose intervertebral disks to early degeneration and hence need to be surgically fused.
  
  
  METHODS
  Lumbar spine configurations, including the height of the intercrestal line, the length of L5 transverse processes, and the presence of transitional vertebrae, were recorded from anteroposterior radiographs taken from 63 consecutive pediatric patients with lumbar disk herniation admitted to our hospital over a period of 8 years. Each configuration was compared in relation to the level of disk herniation. Diskectomy alone was performed in 36 cases; arthrodesis was added in the remaining 27 cases. Patients' back and leg pain visual analog scale scores and frequency and their Oswestry Disability Index scores were recorded before surgery and at follow-up. The results were compared for assessment of outcome.
  
  
  RESULTS
  Patients with high intercrestal lines and long L5 transverse processes had a significantly higher incidence of L4/5 disk herniation, whereas low intercrestal line and lumbarization were associated with L5/S1 disk herniation. Patients' visual analog scale scores, pain frequency, and Oswestry Disability Index score all improved significantly after surgery, but there was no significant difference with or without arthrodesis.
  
  
  CONCLUSIONS
  Pediatric lumbar disk herniation is significantly associated with structural malformations of the lumbar spine, but arthrodesis does not improve the clinical outcome.
  
  
  BACKGROUND
  ICL, intercrestal lineLDH, lumbar disk herniationL5TP, L5 transverse processODI, Oswestry Disability IndexTV, transitional vertebraeVAS, visual analog scale.
authors.affiliation: Orthopaedic Department of Peking University Third Hospital, Beijing, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Dang
authors.forename: Zhongqiang
authors.initials: Z
authors.lastname: Chen
authors.forename: Xiaoguang
authors.initials: X
authors.lastname: Liu
authors.forename: Zhaoqing
authors.initials: Z
authors.lastname: Guo
authors.forename: Qiang
authors.initials: Q
authors.lastname: Qi
authors.forename: Weishi
authors.initials: W
authors.lastname: Li
authors.forename: Yan
authors.initials: Y
authors.lastname: Zeng
authors.forename: Liang
authors.initials: L
authors.lastname: Jiang
authors.forename: Feng
authors.initials: F
authors.lastname: Wei
authors.forename: Chuiguo
authors.initials: C
authors.lastname: Sun
authors.forename: Zhongjun
authors.initials: Z
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001174:Arthrodesis; D002648:Child; D017586:Diskectomy; D005260:Female; D006801:Humans; D007403:Intervertebral Disc; D007405:Intervertebral Disc Displacement / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D008159:Lumbar Vertebrae; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult