Pediatric herniated lumbar disc: a population-based risk factor analysis

Jacob R. LepardDepartment of Neurosurgery, University of Alabama at Birmingham, Alabama

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Kathrin D. ZimmermanDepartment of Neurosurgery, University of Alabama at Birmingham, Alabama

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Anastasia A. ArynchynaDepartment of Neurosurgery, University of Alabama at Birmingham, Alabama

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Jessica A. GutmanDepartment of Neurosurgery, University of Alabama at Birmingham, Alabama

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Arsalaan A. SalehaniDepartment of Neurosurgery, University of Alabama at Birmingham, Alabama

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Brandon G. RocqueDepartment of Neurosurgery, University of Alabama at Birmingham, Alabama

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Curtis J. RozzelleDepartment of Neurosurgery, University of Alabama at Birmingham, Alabama

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OBJECTIVE

Surgical treatment of herniated lumbar disc (HLD) remains rare in children. The purpose of this study was to evaluate for potential disease risk factors leading to surgery based on a large single-center experience.

METHODS

Data for all patients who had undergone surgical treatment for HLD between December 2008 and December 2016 at a single pediatric tertiary care referral center were collected and compared to data for a healthy control population obtained through a Youth Risk Behavior Surveillance System (YRBSS) survey in order to determine relevant disease risk factors. Univariate and multivariate logistic regression were used to determine the effect of potential risk factors.

RESULTS

Twenty-seven patients in the disease cohort and 5212 healthy controls from the general population were included in the risk factor analysis. The mean body mass index was significantly higher in the disease population (30.2 vs 24.0 kg/m2, p < 0.0001). Children who had undergone microdiscectomy were more likely to be obese (OR 7.4, 95% CI 3.46–15.8, p < 0.001). No association was found between lumbar microdiscectomy and sports participation (OR 1.0, 95% CI −0.002 to 0.005, p = 0.37).

CONCLUSIONS

Microdiscectomy remains a viable and safe option in the setting of failed conservative management for pediatric HLD. Childhood obesity is a risk factor for HLD and many other diseases, which increases its importance as a public health priority.

ABBREVIATIONS

BMI = body mass index; HLD = herniated lumbar disc; YRBSS = Youth Risk Behavior Surveillance System.
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Illustration from Purnell et al. (pp. 298–304). Artist: Mike Gallagher. Copyright Jeffrey C. Rastatter. Published with permission.

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