Surgically treated lumbar disc disease in the pediatric population: an outcome study

View More View Less
  • 1 Division of Neurosurgery, The Children's Hospital of Philadelphia, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object. This outcome study was undertaken to investigate the long-term results obtained in surgically treated pediatric patients with lumbar disc disease by using standardized medical outcome scales and clinical follow-up examination.

Methods. Twenty nine patients 17 years of age or younger underwent surgery between 1968 and 1998 for lumbar disc disease. The follow-up period ranged from 4 months to 30.5 years (mean 8.5 years). Outcome scores (health profiles) were generated using a standardized medical outcome scale, the Short Form health survey questionnaire (SF-36), and a condition-specific back pain outcome scale. Clinical follow-up data were obtained by telephone interview.

The health profile of the study population closely paralleled that of the normal population and was distinctly different from the health profile of adults with low-back pain. Only physical functioning, as measured by a scale of the SF-36, was found to be impaired in a subset of the study population. The rate of reoperation was 24% over the course of the follow-up period. In contrast to similar studies in adults, there were no identifiable predictive factors for either reoperation or poor outcome.

Conclusions. Lumbar disc disease in the pediatric population does not appear to lead to chronic complaints of back pain, and it does not appear to have a negative impact on overall health. This finding suggests that pediatric lumbar disc disease may be a separate entity distinct from adult lumbar disc disease, and therefore, the same conclusions regarding long-term outcome cannot be applied to the pediatric population.

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address reprint requests to: Susan R. Durham, M.D., The Children's Hospital of Philadelphia, Pennsylvania, 34th and Civic Center Boulevard, Philadelphia, PA 19104. email: durhamsr@mail.med.upenn.edu.
  • 1.

    Abramovitz JN, & Neff SR: Lumbar disc surgery: results of the Prospective Lumbar Discectomy Study of the Joint Section of Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. Neurosurgery 29:301307, 1991 Abramovitz JN, Neff SR: Lumbar disc surgery: results of the Prospective Lumbar Discectomy Study of the Joint Section of Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. Neurosurgery 29:301–307, 1991

    • Search Google Scholar
    • Export Citation
  • 2.

    Albert TJ, , Mesa JJ, & Eng K, et al. : Health outcome assessment before and after lumbar laminectomy for radiculopathy. Spine 21:960963, 1996 Albert TJ, Mesa JJ, Eng K, et al: Health outcome assessment before and after lumbar laminectomy for radiculopathy. Spine 21:960–963, 1996

    • Search Google Scholar
    • Export Citation
  • 3.

    Andersson GB, & Weinstein JN: Health outcomes related to low back pain. Spine 19:S2026S2027, 1994 Andersson GB, Weinstein JN: Health outcomes related to low back pain. Spine 19:S2026–S2027, 1994

    • Search Google Scholar
    • Export Citation
  • 4.

    Beks JW, & ter Weeme CA: Herniated lumbar discs in teenagers. Acta Neurochir 31:195199, 1975 Beks JW, ter Weeme CA: Herniated lumbar discs in teenagers. Acta Neurochir 31:195–199, 1975

    • Search Google Scholar
    • Export Citation
  • 5.

    Bernard TN Jr: Repeat lumbar spine surgery. Factors influencing outcome. Spine 18:21962200, 1993 Bernard TN Jr: Repeat lumbar spine surgery. Factors influencing outcome. Spine 18:2196–2200, 1993

    • Search Google Scholar
    • Export Citation
  • 6.

    Borgesen SE, & Vang PS: Herniation of the lumbar intervertebral discs in children and adolescents. Acta Orthop Scand 45:540549, 1974 Borgesen SE, Vang PS: Herniation of the lumbar intervertebral discs in children and adolescents. Acta Orthop Scand 45:540–549, 1974

    • Search Google Scholar
    • Export Citation
  • 7.

    Bradford DS, & Garcia A: Herniations of the lumbar intervertebral disc in children and adolescents. A review of 30 surgically treated cases. JAMA 210:20452051, 1969 Bradford DS, Garcia A: Herniations of the lumbar intervertebral disc in children and adolescents. A review of 30 surgically treated cases. JAMA 210:2045–2051, 1969

    • Search Google Scholar
    • Export Citation
  • 8.

    Brazier JE, , Harper R, & Jones NM, et al. : Validating the SF-36 health survey questionnaire: a new outcome measure for primary care. BMJ 305:160164, 1992 Brazier JE, Harper R, Jones NM, et al: Validating the SF-36 health survey questionnaire: a new outcome measure for primary care. BMJ 305:160–164, 1992

    • Search Google Scholar
    • Export Citation
  • 9.

    Carey TS, , Garrett J, & Jackman A, et al. : The outcomes and cost of care for acute low back pain among patients seen by primary care practitioners, chiropractors, and orthopedic surgeons. The North Carolina Back Pain Project. N Engl J Med 333:913917, 1995 Carey TS, Garrett J, Jackman A, et al: The outcomes and cost of care for acute low back pain among patients seen by primary care practitioners, chiropractors, and orthopedic surgeons. The North Carolina Back Pain Project. N Engl J Med 333:913–917, 1995

    • Search Google Scholar
    • Export Citation
  • 10.

    Davis RA: A long-term outcome analysis of 984 surgically treated herniated lumbar discs. J Neurosurg 80:415421, 1994 Davis RA: A long-term outcome analysis of 984 surgically treated herniated lumbar discs. J Neurosurg 80:415–421, 1994

    • Search Google Scholar
    • Export Citation
  • 11.

    DeOrio J, & Bianco A: Lumbar disc excision in children and adolescents. J Bone Joint Surg (Am) 64:991996, 1982 DeOrio J, Bianco A: Lumbar disc excision in children and adolescents. J Bone Joint Surg (Am) 64:991–996, 1982

    • Search Google Scholar
    • Export Citation
  • 12.

    Deyo RA, , Battie M, & Beurskens AJ, et al. : Outcome measures for low back pain research. A proposal for standardized use. Spine 23:20032013, 1998 Deyo RA, Battie M, Beurskens AJ, et al: Outcome measures for low back pain research. A proposal for standardized use. Spine 23:2003–2013, 1998

    • Search Google Scholar
    • Export Citation
  • 13.

    Ebersold MJ, , Quast LM, & Bianco AJ Jr: Results of lumbar discectomy in the pediatric patient. J Neurosurg 67:643647, 1987 Ebersold MJ, Quast LM, Bianco AJ Jr: Results of lumbar discectomy in the pediatric patient. J Neurosurg 67:643–647, 1987

    • Search Google Scholar
    • Export Citation
  • 14.

    Epstein J, & Lavine L: Herniated lumbar intervertebral discs in teen-age children. J Neurosurg 21:10701075, 1964 Epstein J, Lavine L: Herniated lumbar intervertebral discs in teen-age children. J Neurosurg 21:1070–1075, 1964

    • Search Google Scholar
    • Export Citation
  • 15.

    Epstein JA, , Epstein NE, & Marc J, et al. : Lumbar intervertebral disc herniation in teenage children: recognition and management of associated anomalies. Spine 9:427432, 1984 Epstein JA, Epstein NE, Marc J, et al: Lumbar intervertebral disc herniation in teenage children: recognition and management of associated anomalies. Spine 9:427–432, 1984

    • Search Google Scholar
    • Export Citation
  • 16.

    Fisher RG, & Saunders RL: Lumbar disc protrusion in children. J Neurosurg 54:480483, 1981 Fisher RG, Saunders RL: Lumbar disc protrusion in children. J Neurosurg 54:480–483, 1981

    • Search Google Scholar
    • Export Citation
  • 17.

    Garratt AM, , Ruta DA, & Abdalla MI, et al. : The SF36 health survey questionnaire: an outcome measure suitable for routine use within the NHS? BMJ 306:14401444, 1993 Garratt AM, Ruta DA, Abdalla MI, et al: The SF36 health survey questionnaire: an outcome measure suitable for routine use within the NHS? BMJ 306:1440–1444, 1993

    • Search Google Scholar
    • Export Citation
  • 18.

    Garrido E, , Humphreys RP, & Hendrick EB, et al. : Lumbar disc disease in children. Neurosurgery 2:2226, 1978 Garrido E, Humphreys RP, Hendrick EB, et al: Lumbar disc disease in children. Neurosurgery 2:22–26, 1978

    • Search Google Scholar
    • Export Citation
  • 19.

    Gennuso R, , Humphreys RP, & Hoffman HJ, et al. : Lumbar intervertebral disc disease in the pediatric population. Pediatr Neurosurg 18:282286, 1992 Gennuso R, Humphreys RP, Hoffman HJ, et al: Lumbar intervertebral disc disease in the pediatric population. Pediatr Neurosurg 18:282–286, 1992

    • Search Google Scholar
    • Export Citation
  • 20.

    Ghabrial YA, & Tarrant MJ: Adolescent lumbar disc prolapse. Acta Orthop Scand 60:174176, 1989 Ghabrial YA, Tarrant MJ: Adolescent lumbar disc prolapse. Acta Orthop Scand 60:174–176, 1989

    • Search Google Scholar
    • Export Citation
  • 21.

    Ishihara H, , Marsui H, & Hirano N, et al. : Lumbar intervertebral disc herniation in children less than 16 years of age. Long-term follow-up study of surgically managed cases. Spine 22:20442049, 1997 Ishihara H, Marsui H, Hirano N, et al: Lumbar intervertebral disc herniation in children less than 16 years of age. Long-term follow-up study of surgically managed cases. Spine 22:2044–2049, 1997

    • Search Google Scholar
    • Export Citation
  • 22.

    Johnson L: Outcomes analysis in spinal research. How clinical research differs from outcome analysis. Orthop Clin North Am 25:205213, 1994 Johnson L: Outcomes analysis in spinal research. How clinical research differs from outcome analysis. Orthop Clin North Am 25:205–213, 1994

    • Search Google Scholar
    • Export Citation
  • 23.

    Lewis PJ, , Weir BK, & Broad RW, et al. : Long-term prospective study of lumbosacral discectomy. J Neurosurg 67:4953, 1987 Lewis PJ, Weir BK, Broad RW, et al: Long-term prospective study of lumbosacral discectomy. J Neurosurg 67:49–53, 1987

    • Search Google Scholar
    • Export Citation
  • 24.

    Luukkonen M, , Partanen K, & Vapalahti M: Lumbar disc herniations in children: a long-term clinical and magnetic resonance imaging follow-up study. Br J Neurosurg 11:280285, 1997 Luukkonen M, Partanen K, Vapalahti M: Lumbar disc herniations in children: a long-term clinical and magnetic resonance imaging follow-up study. Br J Neurosurg 11:280–285, 1997

    • Search Google Scholar
    • Export Citation
  • 25.

    Lyons RA, , Lo SV, & Littlepage BN: Comparative health status of patients with 11 common illnesses in Wales. J Epidemiol Community Health 48:388390, 1994 Lyons RA, Lo SV, Littlepage BN: Comparative health status of patients with 11 common illnesses in Wales. J Epidemiol Community Health 48:388–390, 1994

    • Search Google Scholar
    • Export Citation
  • 26.

    Martinez-Lage J, , Robledo A, & Lopez F, et al. : Disc protrusion in the child. Particular features and comparison with neoplasms. Childs Nerv Syst 13:201207, 1997 Martinez-Lage J, Robledo A, Lopez F, et al: Disc protrusion in the child. Particular features and comparison with neoplasms. Childs Nerv Syst 13:201–207, 1997

    • Search Google Scholar
    • Export Citation
  • 27.

    McHorney C, , Ware JE Jr, & Rogers W, et al. : The validity and relative precision of MOS short- and long-form health status scales and Dartmouth COOP charts. Results from the Medical Outcomes Study. Med Care 30:S253S265, 1992 McHorney C, Ware JE Jr, Rogers W, et al: The validity and relative precision of MOS short- and long-form health status scales and Dartmouth COOP charts. Results from the Medical Outcomes Study. Med Care 30:S253–S265, 1992

    • Search Google Scholar
    • Export Citation
  • 28.

    O'Connell J: Intervertebral disc protrusions in childhood and adolescence. Br J Surg 47:611616, 1960 O'Connell J: Intervertebral disc protrusions in childhood and adolescence. Br J Surg 47:611–616, 1960

    • Search Google Scholar
    • Export Citation
  • 29.

    Pappas CT, , Harrington T, & Sonntag VK: Outcome analysis in 654 surgically treated lumbar disc herniations. Neurosurgery 30:862866, 1992 Pappas CT, Harrington T, Sonntag VK: Outcome analysis in 654 surgically treated lumbar disc herniations. Neurosurgery 30:862–866, 1992

    • Search Google Scholar
    • Export Citation
  • 30.

    Quigley M, , Bost J, & Maroon J, et al. : Outcome after microdiscectomy: results of a prospective single institutional study. Surg Neurol 49:263268, 1998 Quigley M, Bost J, Maroon J, et al: Outcome after microdiscectomy: results of a prospective single institutional study. Surg Neurol 49:263–268, 1998

    • Search Google Scholar
    • Export Citation
  • 31.

    Rugtveit A: Juvenile lumbar disc herniations. Acta Orthop Scand 37:348356, 1966 Rugtveit A: Juvenile lumbar disc herniations. Acta Orthop Scand 37:348–356, 1966

    • Search Google Scholar
    • Export Citation
  • 32.

    Russwurm H, , Bjerkreim I, & Ronglan E: Lumbar intervertebral disc herniation in the young. Acta Orthop Scand 49:158163, 1978 Russwurm H, Bjerkreim I, Ronglan E: Lumbar intervertebral disc herniation in the young. Acta Orthop Scand 49:158–163, 1978

    • Search Google Scholar
    • Export Citation
  • 33.

    Ruta DA, , Garratt AM, & Wardlaw D, et al. : Developing a valid and reliable measure of health outcome for patients with low back pain. Spine 19:18871896, 1994 Ruta DA, Garratt AM, Wardlaw D, et al: Developing a valid and reliable measure of health outcome for patients with low back pain. Spine 19:1887–1896, 1994

    • Search Google Scholar
    • Export Citation
  • 34.

    Shillito J Jr: Pediatric lumbar disc surgery: 20 patients under 15 years of age. Surg Neurol 46:1418, 1996 Shillito J Jr: Pediatric lumbar disc surgery: 20 patients under 15 years of age. Surg Neurol 46:14–18, 1996

    • Search Google Scholar
    • Export Citation
  • 35.

    Ware JE: SF-36 Health Survey—Manual and Interpretation Guide. Boston: Nimrod Press, 1993 Ware JE: SF-36 Health Survey—Manual and Interpretation Guide. Boston: Nimrod Press, 1993

    • Search Google Scholar
    • Export Citation
  • 36.

    Ware JE Jr, & Sherbourne CD: MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Med Care 30:473483, 1992 Ware JE Jr, Sherbourne CD: MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Med Care 30:473–483, 1992

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 513 118 13
Full Text Views 80 11 0
PDF Downloads 111 8 0
EPUB Downloads 0 0 0