[Lumbar disk hernia in children. Apropos of 12 cases]

Abstract

Lumbar disc herniation in young adolescent is uncommon. Twelve patients of 13 to 16 years old (4 boys and 8 girls) are reported. Traumatic history is encountered only in 1/3 of cases and any spinal abnormality is noted in this series. The rapidity in clinical course is the main difference compared with the lumbosciatalgia of the adult. The mean interval of time between the beginning of clinical signs and surgery is 5 months and a half. A positive straight leg raising test is always present as well as antalgic pseudo-scoliosis. The radiculalgia without lumbalgia is the essential sign in on fourth of cases. The myelography and C.T. scan revealed lumbar disc herniation 5 times in L4-L5 intervertebral space and 7 times in L5-S1 space. The intervertebral disc is reached by unilateral interlaminal approach. The complete removal of the disc is always difficult as the disc is not dehydrated at this age. The radiculalgia disappears immediately in the postoperative period as well as the lumbalgia. The back pain persist some months following the surgery. Up the date any response is noted but the authors think that some prudence is necessary in the evaluation of the results especially because of the incomplete removal of disc in young patients. The authors think also that well hydrated and simply protruded disc of young adolescent may constitute an excellent indication for chemonucleolysis.