Pediatrics severe low back pain by disc herniation: an uncommon entity

BACKGROUND

Common severe back pain due to disc herniation is rare in the paediatric population which involves children under eighteen years of age. Paediatric lumbar disc herniation (LDH) cannot be considered the same disease as in adults, as it has potentially different natural and clinical backgrounds. The treatment of pediatric LDH is the other particularity of this condition. Indeed, in children, delaying surgery for a conservative treatment is justified. We report 3 cases treated in 8 years.

CASE PRESENTATION

Three patients, two of whom were 14 years of age and one 17 years of age, were admitted for L5 or S1 lumbosciatica. A CT scan showed a lumbar disc herniation L5S1 associated with bi-isthmic lysis (and a transitional abnormality in 1 case or spina bifida occulta in 1 other case). The last patient had an magnetic resonance imaging (MRI) that showed a herniated L4L5 disc. The diagnosis of low back pain disc herniation was retained in two patients and that of disabling low back disc in one patient. Percutaneous discolysis in the two hyperalgesic cases and epidural corticosteroid infiltration in the disabling case were effective on lumbosciatica.

CONCLUSION

Paediatric common lomw back pain caused by a disc herniation with a hyperalgic or disabling character posed a therapeutic problem which were solved by the invasive approaches that must be given priority nowadays with children.

Actual epidemiological profile and management of central nervous system (CNS) malformations in a neurosurgery department in sub-Saharan Africa

Introduction: Central Nervous System (CNS) malformations usually leave the family in disarray and doctors’ staff powerless. In developed countries, the rigorous application of preventive measures has contributed to a significant reduction incidence of these malformations. In African societies, mystical-religious considerations and low socio-economic level contribute to the increased occurrence of these malformations.  The purpose of this work was to evaluate the prevalence and management of CNS malformations in our neurosurgical department. Methods: This was a retrospective study conducted in the neurosurgery department of Yalgado Ouedraogo Teaching Hospital, in Ouagadougou, from 2016 to 2019.  All cases of CNS malformations managed in the department with a workable medical record were reviewed. Results:  Five hundred and twenty-four cases were selected. The prevalence of malformations was 7.05%.  The mean age of patients was 1.48 years (1 day and 76 years). Thirty-one (5.9%) cases of CNS malformations were diagnosed antenatally. One hundred and twenty-four (23.6%) ultrasounds (including 51 antenatal), 418 CT scans (79.7%) and 9 MRIs (1.7%) were performed. Hydrocephalus [(n = 219 (41.7%)] and spina bifida [(n = 213 (40.6%)] were the most common pathologies. Surgical treatment was indicated in 435 cases (83%) of which 179 (41.1%) could be operated. After a follow-up of 15.8 months, there were 46.3% sequelae identified. Conclusion:  CNS malformations are common in our context.  They are not always prone to be treated surgically and are at the origin of many neurological sequelae and lifelong disability. Hence there is an urgent need to focus on improving preventive measures in Sub-Saharan Africa.