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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.