Lumbar disc herniation in a 27-month-old child

Case report

View More View Less
  • 1 Department of Neurosurgery, Hospital Español de México, Deleg Miguel Hidalgo, Mexico
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

U The occurrence of disc herniation is rare in children. A 27-month-old child fell from his cradle and developed, in the following 2 weeks, irritability, low-back pain, and difficulty in walking. On physical examination a compensatory gait, paravertebral muscle spasm, and a restricted right straight-leg raising test were demonstrated. Plain x-ray films revealed a narrowed L4–5 intervertebral space. Magnetic resonance imaging of the lumbosacral spine demonstrated decreased signal in the L4–5 disc, with posterior disc protrusion. At surgery, blood infiltrating the subperiosteal plane was observed. Via a left hemilaminectomy and under microscopic magnification, the left L-5 nerve root was found to be intact, and on the right side significant nerve root compression was identified. During dissection an accidental dural tear occurred. A right L-4 hemilaminectomy was performed, and the disc fragments were removed until a complete nerve root decompression was obtained and the dura was repaired. The child recovered uneventfully and was asymptomatic 7 years postsurgery. This child is one of the youngest patients with a herniated disc reported in the world literature. The authors discuss the diagnostic difficulties and management of this entity in children.

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: Rogelio Revuelta, M.D., Neurosurgery Department Hospital Español de México, Ejercito Nacional Ave No. 613 Col Granada Zip Code 11560, Deleg Miguel Hidalgo, Mexico D.F. email: rogelio_revuelta@hotmail.com.
  • 1.

    Balague F, & Nordin M: Back pain in children and teenagers. Baillieres Clin Rheumatol 6:575593, 1992 Balague F, Nordin M: Back pain in children and teenagers. Baillieres Clin Rheumatol 6:575–593, 1992

    • Search Google Scholar
    • Export Citation
  • 2.

    Bradford D, & García A: Herniations of the lumbar intervertebral disk in children and adolescents. A review of 30 surgically treated cases. JAMA 210:20452051, 1969 Bradford D, Garcèa A: Herniations of the lumbar intervertebral disk in children and adolescents. A review of 30 surgically treated cases. JAMA 210:2045–2051, 1969

    • Search Google Scholar
    • Export Citation
  • 3.

    Callahan DJ, , Pack LL, & Bream RC, et al: Intervertebral disc impingement syndrome in a child. Report of a case and suggested pathology. Spine 11:402404, 1986 Callahan DJ, Pack LL, Bream RC, et al: Intervertebral disc impingement syndrome in a child. Report of a case and suggested pathology. Spine 11:402–404, 1986

    • Search Google Scholar
    • Export Citation
  • 4.

    Clarke NM, & Cleak DK: Intervertebral lumbar disc prolapse in children and adolescents. J Pediatr Orthop 3:202206, 1983 Clarke NM, Cleak DK: Intervertebral lumbar disc prolapse in children and adolescents. J Pediatr Orthop 3:202–206, 1983

    • Search Google Scholar
    • Export Citation
  • 5.

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

    • Search Google Scholar
    • Export Citation
  • 6.

    Felsberg GJ, , Tien RD, & Osumi AK, et al: Utility of MR imaging in pediatric spinal cord injury. Pediatr Radiol 25:131135, 1995 Felsberg GJ, Tien RD, Osumi AK, et al: Utility of MR imaging in pediatric spinal cord injury. Pediatr Radiol 25:131–135, 1995

    • Search Google Scholar
    • Export Citation
  • 7.

    Femstrom U: Protruded lumbar intervertebral disc in children: report of a case and review of the literature. Acta Chir Scand 11:7179, 1958 Femstrom U: Protruded lumbar intervertebral disc in children: report of a case and review of the literature. Acta Chir Scand 11:71–79, 1958

    • Search Google Scholar
    • Export Citation
  • 8.

    Garrido E: Lumbar disc herniation in the pediatric patient. Neurosurg Clin North Am 4:149152, 1993 Garrido E: Lumbar disc herniation in the pediatric patient. Neurosurg Clin North Am 4:149–152, 1993

    • Search Google Scholar
    • Export Citation
  • 9.

    Giroux JC, & Leclerq TA: Lumbar disc excision in the second decade. Spine 7:168179, 1982 Giroux JC, Leclerq TA: Lumbar disc excision in the second decade. Spine 7:168–179, 1982

    • Search Google Scholar
    • Export Citation
  • 10.

    Henales V, , Hervas JA, & Lopez P, et al: Intervertebral disc herniation (limbus vertebrae) in pediatric patients: report of 15 cases. Pediatr Radiol 23:608610, 1993 Henales V, Hervas JA, Lopez P, et al:Intervertebral disc herniation (limbus vertebrae) in pediatric patients: report of 15 cases. Pediatr Radiol 23:608–610, 1993

    • Search Google Scholar
    • Export Citation
  • 11.

    Kurihara A, & Katoaka O: Lumbar disc herniation in children and adolescents: a review of 70 operated cases and their minimum 5-year follow-up studies. Spine 5:443451, 1980 Kurihara A, Katoaka O: Lumbar disc herniation in children and adolescents: a review of 70 operated cases and their minimum 5-year follow-up studies. Spine 5:443–451, 1980

    • Search Google Scholar
    • Export Citation
  • 12.

    Love S: The disc factor in low back pain with and without sciatica. J Bone Joint Surg (Am) 29:438447, 1947 Love S: The disc factor in low back pain with and without sciatica. J Bone Joint Surg (Am) 29:438–447, 1947

    • Search Google Scholar
    • Export Citation
  • 13.

    Martinez-Lage JF, , Martinez-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 JF, Martinez-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
  • 14.

    Matsui H, , Terahata N, & Tsuji H, et al: Familial predisposition and clustering for juvenile lumbar disc herniation. Spine 17:13231328, 1992 Matsui H, Terahata N, Tsuji H, et al: Familial predisposition and clustering for juvenile lumbar disc herniation. Spine 17:1323–1328, 1992

    • Search Google Scholar
    • Export Citation
  • 15.

    Nelson CL, , Janecki CJ, & Gildenberg PL, et al: Disc protrusions in the young. Clin Orthop 88:142150, 1972 Nelson CL, Janecki CJ, Gildenberg PL, et al: Disc protrusions in the young. Clin Orthop 88:142–150, 1972

    • Search Google Scholar
    • Export Citation
  • 16.

    Obukhov SK, , Hankenson L, & Manka M, et al: Multilevel lumbar disc heniation in 12-year-old twins. Childs Nerv Syst 12:169171, 1996 Obukhov SK, Hankenson L, Manka M, et al: Multilevel lumbar disc heniation in 12-year-old twins. Childs Nerv Syst 12:169–171, 1996

    • Search Google Scholar
    • Export Citation
  • 17.

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

    • Search Google Scholar
    • Export Citation
  • 18.

    Raaf J: Some observations regarding 905 patients operated upon for protruded lumbar intervertebral disc. Am J Surg 97:388397, 1959 Raaf J: Some observations regarding 905 patients operated upon for protruded lumbar intervertebral disc. Am J Surg 97:388–397, 1959

    • Search Google Scholar
    • Export Citation
  • 19.

    Varlotta GP, , Brown MD, & Kelsey JL, et al: Familial predisposition for herniation of a lumbar disc in patients who are less that twenty-one years old. J Bone Joint Surg (Am) 73:124128, 1991 Varlotta GP, Brown MD, Kelsey JL, et al: Familial predisposition for herniation of a lumbar disc in patients who are less that twenty-one years old. J Bone Joint Surg (Am) 73:124–128, 1991

    • Search Google Scholar
    • Export Citation
  • 20.

    Wahren H: Herniated nucleus pulposus in a child of twelve years. Acta Orthop Scand 16:4042,1945 Wahren H: Herniated nucleus pulposus in a child of twelve years. Acta Orthop Scand 16:40–42,1945

    • Search Google Scholar
    • Export Citation
  • 21.

    Webb JH, , Svlen HJ, & Kennedy RI: Protruded lumbar intervertebral disks in children. JAMA 154:11531155, 1954 Webb JH, Svlen HJ, Kennedy RI: Protruded lumbar intervertebral disks in children. JAMA 154:1153–1155, 1954

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 590 330 30
Full Text Views 76 8 0
PDF Downloads 64 3 0
EPUB Downloads 0 0 0