A review 1 in the European Spine Journal went over the treatments available for Lumbar Disc Herniation (LDH) in children and adolescents. The review shared which treatment showed the best results.
Why Conduct Such a Review?
Research has shared that LDH or lumbar disc herniation, while affecting adults, also impacted children as well as adolescents (pediatric LDH). It is important to note that pediatric LDH has a number of distinctive features due to the physiological natures of children and adolescents being unique.
Due to adult Lumbar Disc Herniation getting a lot of focus, there’s still a lot that needs to be understood about pediatric LDH. One of the areas involves the treatment available for such LDH and the possible effects of such treatments.
The current review study was conducted to help present an in-depth look at treatments for pediatric LDH and what they entail.
What Was the Methodology?
The searching strategy involved a literature search using electronic databases such as PUBMED and EMBASE. MeSH terminologies (adolescent, child, intervertebral disc displacement, and treatment outcome) and keywords (LDH, adolescent, and child) were used. There were no limitations applied.
The inclusion criteria involved articles featuring relevant information about LDH in adolescents and children. Related references were included, too. The clinical outcome in the articles was assessed, too.
Take note; case series that didn’t feature a detailed description of the outcome were excluded. Also, case series involving patients over 21-years-of-age were excluded as well. The age-specific exclusion was because previous research demonstrated the human body had almost reached completion of growth during that time.
In the end, 44 series and a total of 8 case reports (with 1,664 cases) were included in the current review. All of the included articles fell in the 1945 to 2008 timeframe.
What Was Observed?
The review shared that LDH is quite a common disorder among adults. The frequency is believed to be much lower in children and adolescents. In all patients hospitalized for LDH, only 0.5-6.8% of the cases were reported as being pediatric patients.
Pediatric LDH is said to be caused by several potential factors. Self-reported or sport-related injury is considered to be the most common cause. This was because 30-60% of adolescents and children experiencing symptomatic LDH were reported to have a history of trauma before pain occurred. However, adult cases usually didn’t report a traumatic experience before the onset of symptoms.
Some recent studies have suggested trauma being an inciting factor that exacerbated pre-existing lesion in discs.
Another factor is considered to be genetics. It has been reported that 13-57% of adolescents with LDH have a first-degree relative with the same condition.
Looking at it from a clinical perspective, pediatric LDH clinically presents itself similarly to adult LDH. Take note; a distinctive feature is that up to 90% of the patients demonstrated a positive straight-leg raising test.
This can be explained by the fact the nerve root tension is greater in children and adolescents. Also, adolescents and children had a lower chance of presenting neurological symptoms (including weakness and numbness).
What Were the Treatments?
Coming to the treatment part of the review, there’s Conservative treatment, Intradiscal therapy, and Surgical treatment.
Breaking it down, Conservative treatment for pediatric LDH included physical therapy, bed rest, analgesic and anti-inflammatory agents, and limiting physical activity.
As for Intradiscal therapy, chemonucleolysis was the only type being administered for adolescents and children.
Surgical treatment for pediatric LDH was recommended for pediatric LDH on a case-by-case basis. Percutaneous endoscopic discectomy or PED and Microsurgical discectomy or MD were involved.
What Was Concluded?
The review concluded that the diagnosis for adult and pediatric LDH remained similar. As for the treatment, Conservative methods have been reported to be less effective for pediatric LDH when compared to being used for adults. However, Conservative treatment remained the go-to for pediatric LDH cases.
If the said treatment failed, certain patients could be moved to Chemonucleolysis. Excellent short-term outcomes were reported when pediatric LDH was treated surgically (regardless of the modality). Take note; the outcome decreased during the mid-term follow-up, yet it’s considered effective for the long run.
Except for a few exceptions, Spinal fusion isn’t recommended for pediatric LDH.
The review also reported that pediatric LDH could occur in 10-year-olds and younger, with surgical treatments offering positive results.
From this review, one can realize the need to conduct more research involving pediatric LDH for improving treatments and being ready to address any post-treatment related issues.