Early adolescent lumbar intervertebral disc injury: a case study

Abstract

This article describes and discusses the case of an adolescent male with lumbar intervertebral disc injury characterized by chronic low back pain (LBP) and antalgia. A 13-year-old boy presented for care with a complaint of chronic LBP and subsequent loss of quality of life. The patient was examined and diagnosed by means of history, clinical testing and use of imaging. He had showed failure in natural history and conservative management relief in both symptomatic and functional improvement, due to injury to the intervertebral joints of his lower lumbar spine. Discogenic LBP in the young adolescent population must be considered, particularly in cases involving even trivial minor trauma, and in those in which LBP becomes chronic. More research is needed regarding long-term implications of such disc injuries in young people, and how to best conservatively manage these patients. A discussion of discogenic LBP pertaining to adolescent disc injury is included.

Figure 1

Posterior view of patient in neutral lumbar ROM. The posterior view shows a non-distressed young male with no visible scoliosis or antalgia.

Figure 2

Posterior view of patient in end-range active flexion lumbar ROM. This movement reproduced his LBP and created an abnormal right lateral lumbar deviation, appearing to be a possible lumbar scoliotic curve.

Figure 3

Lateral lumbar X-ray view. Note the suspicious area of increased sclerosis in the anterior half of the sacral base.

Figure 4

Antero-posterior X-ray lumbar view. Note the absence of scoliosis.

Figure 5

MRI, sagittal STIR midline image. Annular tears are seen as posterior annulus fibrosus hyperintensity (bottom two arrows pointing to white dots) at L4/5 and L5/S1 discs. Compare with low signal (dark) of the normal L3/4 disc (top arrow).

Figure 6

MRI, sagittal STIR view. The L5/S1 subchondral bone marrow hyperintensity (areas of white) seen on both sides of the L5/S1 disc (arrows), is suggestive of annular injury and ongoing inflammatory response. L4/5 right paramedian disc protrusion, and L5/S1 disc height reduction with dehydration and right posterolateral disc protrusion that appears chronic. Anterior sacral base bone marrow hypointensity indicates chronic marrow repair.