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Review
. 2021 Jan;49(1):300060520986685.
doi: 10.1177/0300060520986685.

Efficacy of percutaneous endoscopic lumbar discectomy for pediatric lumbar disc herniation and degeneration on magnetic resonance imaging: case series and literature review

Ruei-Hong Lin  1 , Hung-Chieh Chen  2   3 , Hung-Chuan Pan  4   5   6 , Hsien-Te Chen  7   8   9 , Chien-Chun Chang  8   9   10 , Chung-Yuh Tzeng  11   12   13 , Tse-Yu Chen  4 , Hsi-Kai Tsou  4   14   15
Affiliations
Review

Efficacy of percutaneous endoscopic lumbar discectomy for pediatric lumbar disc herniation and degeneration on magnetic resonance imaging: case series and literature review

Ruei-Hong Lin et al. J Int Med Res. 2021 Jan.

Abstract

Objective: Pediatric lumbar disc herniation (LDH), although uncommon, causes significant pain, discomfort, and sometimes disability. We examined the efficacy of percutaneous endoscopic lumbar discectomy (PELD) for pediatric LDH and the degree of lumbar disc degeneration at 1 year after PELD.

Methods: We retrospectively reviewed the data of pediatric patients with LDH who underwent PELD from December 2007 to July 2018. The patients' symptoms, physical examination findings, clinical images, visual analog scale (VAS) scores, Oswestry Disability Index (ODI), and perioperative results (blood loss, length of hospital stay, and complications) were obtained from the medical records. Lumbar disc degeneration was graded using the modified Pfirrmann grading system at the 1-year postoperative magnetic resonance imaging (MRI) examination.

Results: Six boys and four girls who underwent PELD were evaluated. The patients' mean age was 15.6 years (range, 13-17 years). The mean VAS score for low back pain, mean VAS score for lower limb pain, and mean ODI preoperatively and 1 year postoperatively were 6.2 and 0.3, 6.9 and 0.5, and 20 and 0.1, respectively. MRI showed significant disc degeneration after PELD.

Conclusions: Treating pediatric LDH with PELD is safe and effective. It relieves pain and reduces disability. However, lumbar disc degeneration still occurs.

Keywords: Pediatric; case series; disc degeneration; literature review; lumbar disc herniation; magnetic resonance imaging; percutaneous endoscopic lumbar discectomy.

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Conflict of interest statement

Declaration of conflicting interest: The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Mean visual analog scale scores for low back pain and lower limb pain. Pre-op, preoperative.
Figure 2.
Figure 2.
Mean ODI. ODI, Oswestry Disability Index; Pre-op, preoperative.
Figure 3.
Figure 3.
Details of sagittal measurements. (a) The sagittal view was obtained from the closest section of all sagittal views to the midline of the vertebral body. (b) Measurements used to determine the disc height index (DHI). a: anterior disc height, b: middle disc height, c: posterior disc height, d: sagittal diameter of the overlying vertebral body. DHI = [(a + b + c) / 3]/d.
Figure 4.
Figure 4.
Details of cross-sectional area (CSA) measurements. (a) The supradiscal level CSA was obtained from the closest section of all axial views parallel to the lower endplate of the upper level vertebral body. (b) The infradiscal level CSA was obtained from the closest section of all axial views parallel to the upper endplate of the lower level. (c) The CSA of the multifidus muscle was measured according to the area enclosed by the green line.
Figure 5.
Figure 5.
Magnetic resonance imaging (MRI) series in a 16-year-old girl. (a) Sagittal view on preoperative MRI. (b) Axial view of L5–S1 on preoperative MRI. (c) Sagittal view on 1-year postoperative MRI. (d) Axial view of L5–S1 on 1-year postoperative MRI.
See this image and copyright information in PMC

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