Herniated Disc in the Child

- Diff Dx: slipped vertebral apophysis

- Discussion:
    - disc herniation is uncommon in children;
    - herniations are most common at the disc spaces between the fourth and fifth lumbar vertebrae & between 5th lumbar and 1st sacral 

- Clinical Findings:
    - children experience little or no back pain, but sciatica is common;
    - positive straight-leg-raise test is most common clinical finding
    - back pain is typically increased by activity & relieved by rest;
    - neurological symptoms or findings are uncommon;

- Radiographs:
    - plain x-rays are usually normal;
    - disc-space narrowing is uncommon;
    - look for associated congenital anomalies in the lumbosacral area:
           - transitional vertebrae;
           - Spinal Stenosis
           - Spina Bifida;
           - lateral recess stenosis (CT);
    - herniated disc can be dx'ed w/ MRI studies, CT scans, or myelography;

- Treatment:
    - initial treatment involves conservative management, including restriction of activities, bed rest, & administration of analgesic medication;
    - if there is no relief of pain, or if there are persistent neurological symptoms, consider operative intervention;
           - this is esp true when there are associated congenital anomalies

Lumbar disc herniation in children.

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Friday, April 13, 2012 1:15 pm