1
|
Vij N, Naron I, Tolson H, Rezayev A, Kaye AD, Viswanath O, Urits I. Back pain in adolescent athletes: a narrative review. Orthop Rev (Pavia) 2022; 14:37097. [PMID: 35936806 PMCID: PMC9353696 DOI: 10.52965/001c.37097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 01/25/2022] [Indexed: 04/28/2024] Open
Abstract
Background Back pain in young athletes is common. Adolescents are at an increased risk for back pain related to several factors including rapid growth. Traditionally, the conversation around back pain in the adolescent age group has been centered around diagnosis and treatment; however, there are emerging studies regarding prevention. Objective The purpose of the present investigation is to summarize sport-specific risk factors, to describe the growing emphasis on prevention/screening, and report results on minimally invasive and surgical options. Methods The literature search was performed in Mendeley. Search fields were varied until redundant. All articles were screened by title and abstract and a preliminary decision to include an article was made. The full-text screening was performed on the selected articles. Any question regarding the inclusion of an article was discussed by at least 3 authors until an agreement was reached. Results Adolescent athletes have a higher risk of developing spondylolysis and spondylolisthesis than their non-athletic counterparts. Participation in athletic activity alone, increased body mass index, varsity status, and nationally/internationally competitive status are identified are demographic risk factors. Weightlifters, gymnasts, football players, and combat athletes may be at higher risks. Increased lumbar lordosis, abdominal muscle weakness, hip flexor tightness, hamstring tightness, thoracolumbar fascia tightness, femoral anteversion, genu recurvatum, and thoracic kyphosis also predispose. Recent cadaveric and kinematic studies have furthered our understanding of pathoanatomic. There is some evidence to suggest that isokinetic testing and electromyographic data may be able to identify at-risk individuals. Perturbation-based exercise interventions can reduce the incidence of adolescent athletic back pain. There is a large body of evidence to support the efficacy of physical therapy. There is some data to support minimally invasive treatments including external bone growth simulators, steroid injections, and chemonucleolysis for specific pathologies. Endoscopic surgery results for a limited subset of patients with certain disease processes are good. Conclusions Back pain in adolescent athletes is common and may not lead to appropriate alterations in athletes' level of participation. Athletes with a higher body mass index should be counseled regarding the benefits of losing weight. Isokinetic testing and electromyographic data have the potential as diagnostic and screening tools. Strength deficits and postural control could be used to identify patients requiring early intervention and thus reduce the incidence. External bone growth simulators, steroid injections, and chemonucleolysis could potentially become conservative options in the future. When surgery is indicated, the endoscopic intervention has the potential to decrease operative time, decrease cost, and promote healing.
Collapse
Affiliation(s)
- Neeraj Vij
- University of Arizona College of Medicine - Phoenix
| | - Ian Naron
- Louisiana State University Health Shreveport School of Medicine
| | | | - Arthur Rezayev
- Louisiana State University Health Shreveport School of Medicine
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Shreveport
| | - Omar Viswanath
- Department of Anesthesiology, Louisiana State University Health Shreveport
| | - Ivan Urits
- Department of Anesthesiology, Louisiana State University Health Shreveport
| |
Collapse
|
2
|
Lin RH, Chen HC, Pan HC, Chen HT, Chang CC, Tzeng CY, Chen TY, Tsou HK. Efficacy of percutaneous endoscopic lumbar discectomy for pediatric lumbar disc herniation and degeneration on magnetic resonance imaging: case series and literature review. J Int Med Res 2021; 49:300060520986685. [PMID: 33472475 PMCID: PMC7829541 DOI: 10.1177/0300060520986685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 12/11/2020] [Indexed: 11/15/2022] Open
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.
Collapse
Affiliation(s)
- Ruei-Hong Lin
- Department of Neurosurgery, Puli
Branch, Taichung Veterans General
Hospital, Puli Township, Nantou county
| | - Hung-Chieh Chen
- Department of Radiology, Taichung Veterans General
Hospital, Taichung
- School of Medicine, National
Yang-Ming University, Taipei
| | - Hung-Chuan Pan
- Functional Neurosurgery Division,
Neurological Institute, Taichung Veterans General
Hospital, Taichung
- Department of Medical Research,
Neurological Institute, Taichung Veterans General
Hospital, Taichung
- Faculty of Medicine, School of
Medicine, National Yang-Ming University, Taipei
| | - Hsien-Te Chen
- Department of Sports Medicine,
College of Health Care, China Medical
University, Taichung
- Department of Orthopedic Surgery, China Medical
University Hospital, China Medical University, Taichung
- Spine Center, China Medical
University Hospital, China Medical University, Taichung
| | - Chien-Chun Chang
- Department of Orthopedic Surgery, China Medical
University Hospital, China Medical University, Taichung
- Spine Center, China Medical
University Hospital, China Medical University, Taichung
- PhD Degree Program of Biomedical
Science and Engineering, National Chiao Tung University, Hsinchu
| | - Chung-Yuh Tzeng
- Department of Orthopedics, Taichung Veterans General
Hospital, Taichung
- Department of Medicinal Botanicals
and Health Applications, Da-Yeh University, Changhua County
- Institute of Biomedical Sciences,
National Chung Hsing University, Taichung
| | - Tse-Yu Chen
- Functional Neurosurgery Division,
Neurological Institute, Taichung Veterans General
Hospital, Taichung
| | - Hsi-Kai Tsou
- Functional Neurosurgery Division,
Neurological Institute, Taichung Veterans General
Hospital, Taichung
- Department of Rehabilitation,
Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli County
- College of Health, National
Taichung University of Science and Technology, Taichung
| |
Collapse
|
3
|
Chen Y, Song R, Huang W, Chang Z. Percutaneous endoscopic discectomy in adolescent lumbar disc herniation: a 3- to 5-year study. J Neurosurg Pediatr 2019; 23:251-258. [PMID: 30485217 DOI: 10.3171/2018.8.peds18442] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 08/15/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe authors sought to investigate the efficiency of percutaneous endoscopic discectomy (PED) in adolescent patients with lumbar disc herniation (LDH), compare PED outcomes in adolescent patients with those in young adult LDH patients as controls, and discuss relevant technical notes.METHODSThis was a retrospective study involving 19 adolescent LDH patients (age > 13 and < 18 years, 20 discectomies) and 38 young adults (age < 40 years, 38 discectomies) who also had LDH and were matched to the adolescent group for sex and body mass index. The combined cohort included 51 male patients (89.5%) and 6 female patients (10.5%), with an average age of 26.7 years (range 14-39 years). The operated levels included L3-4 in 1 patient (1.7%), L4-5 in 22 patients (37.9%), and L5-S1 in 35 patients (60.4%). Two adolescents (10.5%) exhibited apophyseal ring separation and one (5.3%) had had previous PED. All patients underwent PED under local anesthesia. Outcomes were evaluated through a visual analog scale (VAS), the Japanese Orthopaedic Association (JOA) scoring system, and the modified MacNab grading system.RESULTSThe mean duration of follow-up was 41.7 months (range 36-65 months). The outcomes in adolescents were satisfactory and comparable with previously reported outcomes of microsurgical discectomy (MD) and conventional open discectomy (COD). The adolescent patients had a faster and better recovery course than the adult patients (p < 0.01). One adolescent patient (5.3%) exhibited recurrence and 2 adults (5.3%) experienced transient dysesthesia; the complication rates were comparable in the 2 age groups (p = 0.47). Prolonged duration of symptoms (p < 0.01) and disc degeneration (p = 0.01) were correlated with lower postoperative JOA values; patients with extrusions had higher postoperative JOA values than those with protrusions (p = 0.01).CONCLUSIONSPED may yield favorable results in the treatment of adolescent LDH in terms of short- to medium-term follow-up; restricted discectomy and a conservative rehabilitation program might be advisable. Further long-term studies are warranted to address this rare disease entity.
Collapse
|
4
|
Karademir M, Eser O, Karavelioglu E. Adolescent lumbar disc herniation: Impact, diagnosis, and treatment. J Back Musculoskelet Rehabil 2017; 30:347-352. [PMID: 27858699 DOI: 10.3233/bmr-160572] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Symptomatic lumbar intervertebral disc herniation (LDH) is rare in children and adolescents. To date, the treatments available for child and adolescent LDH, and the effect of each treatment, have not been fully reviewed. OBJECTIVE The purpose of this retrospective study is to report the etiology, familial history, presenting symptoms, level of herniation, duration of symptoms, radiological findings, as well as treatment methods and outcome. METHODS We retrospectively reviewed medical records of all patients with inclusion criteria of being younger than 20 years. (10-19 years); we used magnetic resonance imaging (MRI) to confirm lumbar disc herniations between 2013 and 2016. All patients were followed up for a minimum of 12 months and discharged if they remained almost asymptomatic for 6 months. All patients were treated conservatively and 6 patients they have progressive neurological deficit and persistent back pain, were treated with surgical procedures. The Visual Analogue Scale (VAS), as well as the Oswestry Disability Scale (ODS) and the modified Ashworth Scale (AS) were used to analyze physical examination findings both before and after treatment. To detect lumbar disc degeneration, we used the modified Pfirrmann grading system with MRI. All statistical analyses were performed with commercially available SPSS 15.0 software, while p ≤ 0.05 was considered statistically significant. RESULTS A total of 70 cases with lumbar disc herniation have been treated. The mean age was 17.14 ± 2.15 years (range 9-19 years). The male to female ratio was 35:35. The mean duration of symptoms was 7.21 ± 1.69 months. The follow-up duration was 17.31 ± 4.17 months. The most common level was L4-5 in 38 (54%) patients and the second was L5-S1 in 24 (34%) patients. Subligamentous protruded discs were found in 42 (60%), extruded in 6 (9%), and disc bulge with intact annulus in 22 (31%) cases. VAS before treatment was 6.05 ± 0.83, while at 6 months after treatment it was 3.1 ± 0.6. However, at the first-year examination, VAS was 2.17 ± 0.76. The ODS was indexed before treatment 42.03 ± 3.75, at 6 months being 25.01 ± 2.75 and at the first year 9.92 ± 2.67. VAS and the OSD were both significantly decreased after treatment (p < 0.05). CONCLUSIONS Either conservative or surgical methods can be performed comfortably for adolescent lumbar disc herniations. We proposed surgical treatment for patients with incapacitating persistent low back pain or radicular pain that lasted more than 6 weeks, despite rest and medication. We also pursued the development of neurological deficits, including recurrent pain that disturbed routine life activities.
Collapse
Affiliation(s)
- Mustafa Karademir
- Department of Neurosurgery, Afyonkarahisar State Hospital, Afyonkarahisar, Turkey
| | - Olcay Eser
- Department of Neurosurgery, Balıkesir University, Balıkesir, Turkey
| | - Ergün Karavelioglu
- Department of Neurosurgery, Afyon Kocatepe University, Afyonkarahisar, Turkey
| |
Collapse
|
5
|
Hao Y, Liu T, Yu L, Ma C, Liu Y, Li Z, Zhang D. [Percutaneous transforaminal endoscopic discectomy combined with Coflex interspinous process dynamic reconstruction system in treatment of youth lumbar disc herniation]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:191-196. [PMID: 29786252 PMCID: PMC8458143 DOI: 10.7507/1002-1892.201608062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 12/17/2016] [Indexed: 11/03/2022]
Abstract
Objective To evaluate the effectiveness of percutaneous transforaminal endoscopic discectomy (PTED) combined with Coflex interspinous process dynamic reconstruction system for the treatment of youth lumbar disc herniation (LDH). Methods The clinical data of 52 patients with LDH treated by PTED combined with Coflex were retrospectively analyzed between February 2013 and March 2015. The involved segments were L 4, 5 in 30 cases and L 5, S 1 in 22 cases. In 30 patients at L 4, 5 level, there were 18 males and 12 females with an average age of 25 years (range, 18-34 years) and a mean disease duration of 10 months (range, 6-16 months). In 22 patients at L 5, S 1 level, there were 10 males and 12 females with an average age of 25.5 years (range, 19-32 years) and a mean disease duration of 12 months (range, 6-18 months). The operation time and intraoperative blood loss were recorded. Oswestry disability index (ODI) and Japanese Orthpoaedic Association (JOA) score were used for effectiveness assessment. Radiograpic indexes were calculated on X-ray films before operation and final follow-up, including ventral intervertebral space height (VH), dorsal intervertebral space height (DH), intervertebral foramen height (IFH), the range of motion (ROM) of involved segment, and the ROM of upper adjacent segment. Results The operations were successfully completed in 52 patients. The operation time and intraoperative blood loss were (89.7±16.5) minutes and (42.7±11.3) mL in patients at L 4, 5 level, and were (94.6±18.2) minutes and (47.6±13.4) mL in patients at L 5, S 1 level. Incisions healed by first intention. All patients were followed up 12-18 months (mean,16 months) in patients at L 4, 5 level and 12-20 months (mean, 17 months) in patients at L 5, S 1 level. At final follow-up, ODI, and JOA score were significantly improved when compared with preoperative ones in all patients ( P<0.05). X-ray films showed no complication of Coflex loosening, spinous process fracture, or articular process fracture occurred. At final follow-up, VH, DH, and IFH were significantly improved when compared with preoperative ones in all patients ( P<0.05), and the ROM of involved segment was significantly reduced compared with preoperative one ( P<0.05), but the ROM of upper adjacent segment showed no significant difference when compared with preoperative one ( P>0.05). Conclusion PTED combined with Coflex is a safe and effective minimally invasive surgery in treating youth LDH; however, it still needs further clinical studies.
Collapse
Affiliation(s)
- Yingjie Hao
- Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052,
| | - Tao Liu
- Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052, P.R.China
| | - Lei Yu
- Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052, P.R.China
| | - Caoyuan Ma
- Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052, P.R.China
| | - Yawei Liu
- Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052, P.R.China
| | - Zhilei Li
- Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052, P.R.China
| | - Di Zhang
- Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052, P.R.China
| |
Collapse
|
6
|
Haddadi K. Pediatric Lumbar Disc Herniation: A Review of Manifestations, Diagnosis and Management. JOURNAL OF PEDIATRICS REVIEW 2016. [DOI: 10.17795/jpr-4725] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
|
7
|
Li B, Xu XX, Du Y, Yang HF, Li Y, Zhang Q, Huang YY, Meng J. CT-guided chemonucleolysis combined with psoas compartment block in lumbar disc herniation: a randomized controlled study. PAIN MEDICINE 2014; 15:1470-6. [PMID: 25041326 DOI: 10.1111/pme.12491] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The study was designed to evaluate the effectiveness of the combination of chemonucleolysis and psoas compartment block (PCB) for the treatment of lumbar disc herniations (LDHs) and to explore the role of PCB in managing postoperative pain of collagenase injection. METHODS Two groups of patients (N = 192) were treated in different ways, respectively. Group A (N = 95) was treated with chemonucleolysis only (the injection of oxygen-ozone combined with collagenase into the lumbar disc and the epidural space); group B (N = 97) was treated with chemonucleolysis and PCB. After the treatment, the patients were followed-up, and the therapeutic effect was assessed at 1 week, 1 month, 3 months, and 6 months by the relative pain reduction, visual analog scale (VAS) pain scores, and the Oswestry Disability Index (ODI) scores. RESULTS In group A, treatment success rate was 64.2% (61 of 95), 82.1% (78 of 95), 84.2% (80 of 95), and 86.3% (82 of 95) at 1 week, 1 month, 3 months, and 6 months, respectively. In group B, treatment success rate was 86.5% (84 of 97), 89.6% (87 of 97), 93.8% (91 of 97), and 91.7% (89 of 97) at 1 week, 1 month, 3 months, and 6 months, respectively. There was statistically significant difference in outcome between two groups at 1 week, but there were no statistically significant difference in outcome between two groups at 1 month, 3 months, and 6 months. VAS scores and ODI were significantly decreased in both group A and group B, when compared with the baseline values in the same group at all points of follow-up. Group B produced a significant reduction in the VAS scores and ODI when compared with group A at: 1-week, 1-month, 3-month, 6-month follow-up. CONCLUSIONS Computer tomography (CT)-guided chemonucleolysis combined with PCB leads to rapid pain relief, fewer postoperative pain of collagenase injection happen, and should be regarded as a useful treatment for the management of LDH.
Collapse
Affiliation(s)
- Bing Li
- Sichuan Key Laboratory of Medical Imaging, Affiliated Hospital of North Sichuan Medical College, Nanchong, China; Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | | | | | | | | | | | | | | |
Collapse
|
8
|
Adolescent lumbar disc herniation: Experience from a large minimally invasive treatment centre for lumbar degenerative disease in Chongqing, China. Clin Neurol Neurosurg 2013; 115:1415-9. [DOI: 10.1016/j.clineuro.2013.01.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 12/24/2012] [Accepted: 01/20/2013] [Indexed: 11/20/2022]
|
9
|
Kwon DW, Kim KH, Park JY, Chin DK, Kim KS, Cho YE, Kuh SU. Clinical outcomes and considerations of the lumbar interbody fusion technique for lumbar disk disease in adolescents. Childs Nerv Syst 2013; 29:1339-44. [PMID: 23545596 DOI: 10.1007/s00381-013-2088-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 03/18/2013] [Indexed: 11/27/2022]
Abstract
PURPOSE The posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) techniques are commonly used surgical methods for wide indications such as degeneration or trauma. Although they are rarely required for lumbar disk disease in younger patients, there are a few children and adolescents who are indicated for PLIF or TLIF for other reasons, such as congenital severe stenosis with or without lumbar instability that requires wide decompression or severe bony spur that need to be removed. In such cases, different pathophysiology and outcomes are expected compared with adult patients. METHODS We retrospectively reviewed data of 23 patients who underwent PLIF or TLIF surgery when less than 20 years old. Clinical and radiographic outcomes were assessed during a mean of 36.4 months follow-up period. The indications of lumbar interbody fusion, success of fusion, complications, and visual analog scale (VAS) were analyzed. RESULTS Radiographs of all patients taken 6 months after the surgery showed fusion. Clinical outcome was also satisfactory, with improvement of VAS score from 7.7 preoperatively to 2.3 at 6 months after surgery. Only one patient had reoperation due to adjacent segment disease. CONCLUSIONS For adolescent patients with severe bony spur, massive central disk rupture, or severe spondylolisthesis, lumbar interbody fusion surgery has good surgical outcome with few complications.
Collapse
Affiliation(s)
- Dae-Woong Kwon
- Department of Spinal Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University Collegeof Medicine, 712, Eonjuro, Gangnam-gu, Seoul, Republic of Korea
| | | | | | | | | | | | | |
Collapse
|
10
|
Wu X, Ma W, Du H, Gurung K. A review of current treatment of lumbar posterior ring apophysis fracture with lumbar disc herniation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012. [PMID: 23179980 DOI: 10.1007/s00586-012-2580-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Lumbar posterior ring apophysis fracture (PRAF) is an uncommon disorder frequently accompanied by lumbar disc herniation (LDH). Over the years, there have constantly been published studies concerning this disorder. Due to its rarity, there is lack of an agreed treatment strategy, and lots of different opinions exist, including the choice of decompressive modalities, whether removal of apophyseal fragments or/and disc material, and the necessity of additional spinal fusion. The purpose of this review is to provide a collective opinion on the treatment of PRAF with LDH. METHODS A MEDLINE search in the English language literature was performed from 1980 to 2012. To be included in the study, it was strictly necessary for each clinical article to provide information about the description of apophyseal fracture such as location, treatment methods and clinical outcome. The studies were mainly analyzed for general features, the related classifications and treatments. RESULTS The literature searching yielded 19 articles reporting 366 patients experiencing 380 sites of fractures. All of them were case reports or case series. The classification systems of PRAF were various based on the morphology, mobilization, size or localization, and relationship between disc and fragment. The most used surgical options were posterior discectomy simultaneous excision of apophyseal fragments without spine fusion. Surgical treatment for PRAF with LDH had equally excellent clinical outcome compared with LDH alone. CONCLUSIONS The diverse features of apophyseal fracture lead to various modalities of classifications and operation options. Prior to operation, the surgeons should carefully make a plan to consider decompressive scope, removal of apophyseal fragment or/and disc and fusion or not. Because of methodological shortcomings in publications, it is not possible to definitively conclude what treatment modality is the best for the treatment of PRAF. More high-quality clinical studies are needed to draw more confirmable conclusions.
Collapse
Affiliation(s)
- Xueyuan Wu
- Department of Orthopaedics, The First Affiliated Hospital, Medical School of Xi'an JiaoTong University, Yan Ta Western Road No 227, Shanxi, 710061 Xi'an, China
| | | | | | | |
Collapse
|
11
|
Abstract
Lumbar posterior ring apophysis fracture (PRAF) is an uncommon cause of low back pain in the pediatric age group, and a detailed understanding of this disease is important for the orthopaedic surgeon because it is easily misdiagnosed. However, to date no comprehensive review of PRAF has been published. The majority of published reports are in the form of cases report generally targeted at either diagnosis or therapy, or both. In this essay, we comprehensively review the pathogenesis, clinical presentation, diagnosis and treatment of PRAF.
Collapse
Affiliation(s)
- Xue-yuan Wu
- Department of Orthopaedic Surgery, The First Affiliated Hospital Of Xi'an, Xi'an, China
| | | |
Collapse
|
12
|
Dang L, Liu Z. A review of current treatment for lumbar disc herniation in children and adolescents. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 19:205-14. [PMID: 19890666 PMCID: PMC2899810 DOI: 10.1007/s00586-009-1202-7] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2009] [Revised: 10/15/2009] [Accepted: 10/18/2009] [Indexed: 10/20/2022]
Abstract
Lumbar disc herniation (LDH) is a common disorder among adults with degenerated lumbar intervertebral discs. However, its occurrence in childhood and adolescence is much less frequent mostly because children and adolescents tend to have a healthier lumbar spine as compared with adults. This difference indicates that children and adolescents are far from being just little adults. Over the years, there have constantly been published studies concerning this entity where the findings suggested that pediatric LDH is, in many ways, different from that in adults. To date, the prevalence, the etiological and the diagnostic features of pediatric LDH have been fully described in the literature whereas the characteristics regarding to the treatment is yet to be reviewed in details. The aim of the present review is to provide a collective opinion on the treatment of pediatric LDH as well as its outcome. It reviewed the relevant information available in the literature and compared the results among and within various treatments. It was found that pediatric patients responded less favorably to conservative treatment as compared with adults. In addition, the outcome of surgery remained to be satisfactory for at least 10 years after the initial operation, even though it appeared to deteriorate slightly. To the best of our knowledge, this is the first literature review focusing on the treatment of pediatric LDH.
Collapse
Affiliation(s)
- Lei Dang
- Orthopedic Department, Peking University Third Hospital, Haidian District, Beijing, People's Republic of China.
| | | |
Collapse
|
13
|
Furlan AD, Tomlinson G, Jadad A(AR, Bombardier C. Methodological quality and homogeneity influenced agreement between randomized trials and nonrandomized studies of the same intervention for back pain. J Clin Epidemiol 2008; 61:209-31. [DOI: 10.1016/j.jclinepi.2007.04.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2006] [Revised: 04/02/2007] [Accepted: 04/21/2007] [Indexed: 11/26/2022]
|
14
|
Abstract
Intervertebral disk herniation in pediatric patients is a rare but potentially disabling entity that is frequently difficult to diagnose. This article reviews the fundamentals of pediatric intervertebral disk herniation with the intention of presenting a rational and simple strategy for the evaluation and treatment of disk herniation in children, with specific emphasis on how it differs from adult disk disease in presentation, pathologic findings, and treatment options.
Collapse
Affiliation(s)
- Jonathan R Slotkin
- Department of Neurosurgery, The Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | | | | | | |
Collapse
|
15
|
Ozgen S, Konya D, Toktas OZ, Dagcinar A, Ozek MM. Lumbar disc herniation in adolescence. Pediatr Neurosurg 2007; 43:77-81. [PMID: 17337916 DOI: 10.1159/000098377] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Accepted: 07/19/2006] [Indexed: 11/19/2022]
Abstract
Lumbar disc herniation very rarely occurs in adolescence. The aim of this study was to assess the radiological, clinical and surgical features and case outcomes for adolescents with lumbar disc herniation, and to compare with adult cases. The cases of 17 adolescents (7 girls and 10 boys, age range 13-17 years) who were surgically treated for lumbar disc herniation in our clinic between 1998 and 2003 were retrospectively reviewed. The mean follow-up time for these cases was 60 months. The collected histories revealed that 14 (82%) of the 17 cases involved trauma or intense sports activity. Low back pain was the most common complaint (15 cases, 88%). None of the 17 patients had major symptoms during follow-up, and most were engaged in intense sports or heavy work-related activities during this period. The main features of lumbar disc herniation in adolescents are different from those seen in adults. Careful assessment is vital to avoid misdiagnosis and prevent undesirable results from inappropriate surgery. When surgery is indicated and patients are carefully selected, the results of lumbar discectomy in adolescence can be satisfactory.
Collapse
Affiliation(s)
- Serdar Ozgen
- Department of Neurosurgery, Marmara University Faculty of Medicine, Istanbul, Turkey
| | | | | | | | | |
Collapse
|