Surgical management of herniated intervertebral disc in children

Study design: Retrospective literature review analysis Objective: Analyze the risk factors, characteristics, outcome, and follow up of surgical management of disc herniation in children <= 15 years old (y.o) through a review of the literature. Background: Disc herniation is a rare disease in the pediatric population. While conservative treatment if very often tried, some cases require surgical treatment. Methods: A literature search was conducted using PubMed data base using the terms 'pediatric/children/ adolescent disc herniation' and 'surgical management' as key words. Significant manuscripts i.e: case reports, case series, reviews were identified and analyzed. The exclusion criteria were: series and cases with patients >15 y.o, results non-individualizable and medical management. Results: 49 studies were identified, 28 were retained. 69 children <15 y.o were identified with a median age of 13 y.o (SD 1-15). The mean FU was 3.3 years. Trauma and repeated micro traumatism were identified as the main causes of disc herniation in this population. It is mostly a lumbar disease, with very anecdotic cases of thoracic or cervical herniation described. In the absence of neurological deficit, conservative treatment should be tried. Different types of surgery exist (open, endoscopic, tubular), with no difference in outcome or complications. The post-operative outcome was very satisfactory, with no neurological sequalae described with excellent recovery. Conclusions: Pediatric disc herniation is often caused by precipitating factors such as trauma. In the absence of resolution with conservative treatment, surgical options yield favorable short term clinical outcomes with minimal complications and no neurological sequalae.