European Spine Journal

, Volume 19, Issue 2, pp 205–214 | Cite as

A review of current treatment for lumbar disc herniation in children and adolescents

  • Lei DangEmail author
  • Zhongjun Liu
Review Article


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.


Child Adolescent Therapeutics Treatment outcome Intervertebral disc displacement Lumbar disc herniation 


  1. 1.
    Zucker L, Amacher AL, Eltomey A (1987) Juvenile lumbar discs. Childs Nerv Syst 3:125–127CrossRefPubMedGoogle Scholar
  2. 2.
    Frymoyer JW, Pope MH, Clements JH, Wilder DG, MacPherson B, Ashikaga T (1983) Risk factors in low-back pain. An epidemiological survey. J Bone Joint Surg Am 65:213–218PubMedGoogle Scholar
  3. 3.
    Epstein JA, Lavine LS (1964) Herniated lumbar intervertebral discs in teen-age children. J Neurosurg 21:1070–1075CrossRefPubMedGoogle Scholar
  4. 4.
    Grobler LJ, Simmons EH, Barrington TW (1979) Intervertebral disc herniation in the adolescent. Spine 4:267–278CrossRefPubMedGoogle Scholar
  5. 5.
    Garrido E, Humphreys RP, Hendrick EB, Hoffman HJ (1978) Lumbar disc disease in children. Neurosurgery 2:22–26CrossRefPubMedGoogle Scholar
  6. 6.
  7. 7.
    Zitting P, Rantakallio P, Vanharanta H (1998) Cumulative incidence of lumbar disc diseases leading to hospitalization up to the age of 28 years. Spine 23:2337–2343 (discussion 2334–2343)CrossRefPubMedGoogle Scholar
  8. 8.
    Kurihara A, Kataoka O (1980) Lumbar disc herniation in children and adolescents. A review of 70 operated cases and their minimum 5-year follow-up studies. Spine 5:443–451CrossRefPubMedGoogle Scholar
  9. 9.
    Durham SR, Sun PP, Sutton LN (2000) Surgically treated lumbar disc disease in the pediatric population: an outcome study. J Neurosurg 92:1–6CrossRefPubMedGoogle Scholar
  10. 10.
    Gennuso R, Humphreys RP, Hoffman HJ, Hendrick EB, Drake JM (1992) Lumbar intervertebral disc disease in the pediatric population. Pediatr Neurosurg 18:282–286CrossRefPubMedGoogle Scholar
  11. 11.
    Shillito J Jr (1996) Pediatric lumbar disc surgery: 20 patients under 15 years of age. Surg Neurol 46:14–18CrossRefPubMedGoogle Scholar
  12. 12.
    Papagelopoulos PJ, Shaughnessy WJ, Ebersold MJ, Bianco AJ Jr, Quast LM (1998) Long-term outcome of lumbar discectomy in children and adolescents sixteen years of age or younger. J Bone Joint Surg Am 80:689–698CrossRefPubMedGoogle Scholar
  13. 13.
    Beks JW, ter Weeme CA (1975) Herniated lumbar discs in teenagers. Acta Neurochir (Wien) 31:195–199CrossRefGoogle Scholar
  14. 14.
    Kumar R, Kumar V, Das NK, Behari S, Mahapatra AK (2007) Adolescent lumbar disc disease: findings and outcome. Childs Nerv Syst 23:1295–1299CrossRefPubMedGoogle Scholar
  15. 15.
    Parisini P, Di Silvestre M, Greggi T, Miglietta A, Paderni S (2001) Lumbar disc excision in children and adolescents. Spine 26:1997–2000CrossRefPubMedGoogle Scholar
  16. 16.
    Zamani MH, MacEwen GD (1982) Herniation of the lumbar disc in children and adolescents. J Pediatr Orthop 2:528–533PubMedGoogle Scholar
  17. 17.
    Clarke NM, Cleak DK (1983) Intervertebral lumbar disc prolapse in children and adolescents. J Pediatr Orthop 3:202–206PubMedGoogle Scholar
  18. 18.
    DeLuca PF, Mason DE, Weiand R, Howard R, Bassett GS (1994) Excision of herniated nucleus pulposus in children and adolescents. J Pediatr Orthop 14:318–322PubMedGoogle Scholar
  19. 19.
    Bradford DS, Garcia A (1969) Herniation of the lumbar intervertebral disc in children and adolescents. JAMA 210:2045–2051CrossRefPubMedGoogle Scholar
  20. 20.
    DeOrio JK, Bianco AJ Jr (1982) Lumbar disc excision in children and adolescents. J Bone Joint Surg Am 64:991–996PubMedGoogle Scholar
  21. 21.
    Ebersold MJ, Quast LM, Bianco AJ Jr (1987) Results of lumbar discectomy in the pediatric patient. J Neurosurg 67:643–647CrossRefPubMedGoogle Scholar
  22. 22.
    Yang IK, Bahk YW, Choi KH, Paik MW, Shinn KS (1994) Posterior lumbar apophyseal ring fractures: a report of 20 cases. Neuroradiology 36:453–455CrossRefPubMedGoogle Scholar
  23. 23.
    Banerian KG, Wang AM, Samberg LC, Kerr HH, Wesolowski DP (1990) Association of vertebral end plate fracture with pediatric lumbar intervertebral disk herniation: value of CT and MR imaging. Radiology 177:763–765PubMedGoogle Scholar
  24. 24.
    Smorgick Y, Floman Y, Millgram MA, Anekstein Y, Pekarsky I, Mirovsky Y (2006) Mid- to long-term outcome of disc excision in adolescent disc herniation. Spine J 6:380–384CrossRefPubMedGoogle Scholar
  25. 25.
    Epstein JA, Epstein NE, Marc J, Rosenthal AD, Lavine LS (1984) Lumbar intervertebral disk herniation in teenage children: recognition and management of associated anomalies. Spine 9:427–432CrossRefPubMedGoogle Scholar
  26. 26.
    Matsui H, Kitagawa H, Kawaguchi Y, Tsuji H (1995) Physiological changes of nerve root during posterior lumbar discectomy. Spine 20:654–659CrossRefPubMedGoogle Scholar
  27. 27.
    Ozgen S, Konya D, Toktas OZ, Dagcinar A, Ozek MM (2007) Lumbar disc herniation in adolescence. Pediatr Neurosurg 43:77–81CrossRefPubMedGoogle Scholar
  28. 28.
    Oxford Centre for Evidence-based Medicine (2001) Levels of evidence. http://wwwcebmnet/indexaspx?o=1025
  29. 29.
    Slotkin JR, Mislow JM, Day AL, Proctor MR (2007) Pediatric disk disease. Neurosurg Clin N Am 18:659–667CrossRefPubMedGoogle Scholar
  30. 30.
    Ippolito E, Versari P, Lezzerini S (2006) The role of rehabilitation in juvenile low back disorders. Pediatr Rehabil 9:174–184PubMedGoogle Scholar
  31. 31.
    Hahn YS (1999) Intervertebral disc diseases. In: Albright L, Pollack I, Adelson D (eds) Principles and practice of pediatric neurosurgery. Thieme Medical, New York, pp 433–445Google Scholar
  32. 32.
    Kurth AA, Rau S, Wang C, Schmitt E (1996) Treatment of lumbar disc herniation in the second decade of life. Eur Spine J 5:220–224CrossRefPubMedGoogle Scholar
  33. 33.
    Bulos S (1973) Herniated intervertebral lumbar disc in the teenager. J Bone Joint Surg Br 55:273–278PubMedGoogle Scholar
  34. 34.
    Kamel M, Rosman M (1984) Disc protrusion in the growing child. Clin Orthop Relat Res 185:46–52PubMedGoogle Scholar
  35. 35.
    Villarejo-Ortega FJ, Torres Campa-Santamarina JM, Bencosme-Abinader JA, Alvarez-Sastre C, Pascual Martin-Gamero A, Perez-Diaz C, Cordobes-Tapia F, Gonzalez-Mediero I (2003) Lumbar disc disease in adolescents. Rev Neurol 36:514–517PubMedGoogle Scholar
  36. 36.
    Baba H, Uchida K, Furusawa N, Maezawa Y, Azuchi M, Kamitani K, Annen S, Imura S, Tomita K (1996) Posterior limbus vertebral lesions causing lumbosacral radiculopathy and the cauda equina syndrome. Paraplegia 34:427–432Google Scholar
  37. 37.
    Silvers HR, Lewis PJ, Clabeaux DE, Asch HL (1994) Lumbar disc excisions in patients under the age of 21 years. Spine 19:2387–2391 (discussion 2392)CrossRefPubMedGoogle Scholar
  38. 38.
    King HA (1999) Back pain in children. Orthop Clin N Am 30:467–474, ixGoogle Scholar
  39. 39.
    Weinert AM Jr, Rizzo TD Jr (1992) Nonoperative management of multilevel lumbar disk herniations in an adolescent athlete. Mayo Clin Proc 67:137–141PubMedGoogle Scholar
  40. 40.
    Revuelta R, De Juambelz PP, Fernandez B, Flores JA (2000) Lumbar disc herniation in a 27-month-old child. Case report. J Neurosurg 92:98–100PubMedGoogle Scholar
  41. 41.
    Kuh SU, Kim YS, Cho YE, Yoon YS, Jin BH, Kim KS, Chin DK (2005) Surgical treatments for lumbar disc disease in adolescent patients; chemonucleolysis/microsurgical discectomy/PLIF with cages. Yonsei Med J 46:125–132CrossRefPubMedGoogle Scholar
  42. 42.
    Simmons JW, Nordby EJ, Hadjipavlou AG (2001) Chemonucleolysis: the state of the art. Eur Spine J 10:192–202CrossRefPubMedGoogle Scholar
  43. 43.
    Lorenz M, McCulloch J (1985) Chemonucleolysis for herniated nucleus pulposus in adolescents. J Bone Joint Surg Am 67:1402–1404PubMedGoogle Scholar
  44. 44.
    Bradbury N, Wilson LF, Mulholland RC (1996) Adolescent disc protrusions. A long-term follow-up of surgery compared to chymopapain. Spine 21:372–377CrossRefPubMedGoogle Scholar
  45. 45.
    Van Alphen HA, Braakman R, Bezemer PD, Broere G, Berfelo MW (1989) Chemonucleolysis versus discectomy: a randomized multicenter trial. J Neurosurg 70:869–875CrossRefPubMedGoogle Scholar
  46. 46.
    Luukkonen M, Partanen K, Vapalahti M (1997) Lumbar disc herniations in children: a long-term clinical and magnetic resonance imaging follow-up study. Br J Neurosurg 11:280–285CrossRefPubMedGoogle Scholar
  47. 47.
    Mayer HM, Mellerowicz H, Dihlmann SW (1996) Endoscopic discectomy in pediatric and juvenile lumbar disc herniations. J Pediatr Orthop B 5:39–43PubMedGoogle Scholar
  48. 48.
    Lee DY, Ahn Y, Lee SH (2006) Percutaneous endoscopic lumbar discectomy for adolescent lumbar disc herniation: Surgical outcomes in 46 consecutive patients. Mt Sinai J Med 73:864–870PubMedGoogle Scholar
  49. 49.
    Ishihara H, Matsui H, Hirano N, Tsuji H (1997) Lumbar intervertebral disc herniation in children less than 16 years of age. Long-term follow-up study of surgically managed cases. Spine 22:2044–2049CrossRefPubMedGoogle Scholar
  50. 50.
    Leong JC, Hooper G, Fang D, Chun SY (1982) Disc excision and anterior spinal fusion for lumbar disc protrusion in the adolescent. Spine 7:623–626CrossRefPubMedGoogle Scholar
  51. 51.
    Bayliss MT, Johnstone B, O’Brien JP (1988) 1988 Volvo award in basic science. Proteoglycan synthesis in the human intervertebral disc. Variation with age, region and pathology. Spine 13:972–981CrossRefPubMedGoogle Scholar
  52. 52.
    Pietila TA, Stendel R, Kombos T, Ramsbacher J, Schulte T, Brock M (2001) Lumbar disc herniation in patients up to 25 years of age. Neurol Med Chir (Tokyo) 41:340–344CrossRefGoogle Scholar
  53. 53.
    Ferrante L, Mastronardi L, Lunardi P, Puzzilli F, Fortuna A (1992) Lumbar disc herniation in teenagers. Eur Spine J 1:25–28CrossRefPubMedGoogle Scholar
  54. 54.
    Ghabrial YA, Tarrant MJ (1989) Adolescent lumbar disc prolapse. Acta Orthop Scand 60:174–176PubMedGoogle Scholar
  55. 55.
    Plangger C, Mohsenipour I, Twerdy K, Fischer J (1989) Lumbar disk hernia in children and adolescents. Zentralbl Neurochir 50:159–161PubMedGoogle Scholar
  56. 56.
    Borgesen SE, Vang PS (1974) Herniation of the lumbar intervertebral disk in children and adolescents. Acta Orthop Scand 45:540–549PubMedCrossRefGoogle Scholar
  57. 57.
    Rugtveit A (1966) Juvenile lumbar disc herniations. Acta Orthop Scand 37:348–356PubMedCrossRefGoogle Scholar
  58. 58.
    O’Connell JE (1960) Intervertebral disk protrusions in childhood and adolescence. Br J Surg 47:611–616CrossRefPubMedGoogle Scholar
  59. 59.
    Chen LH, Chang CH, Lee ZL, Niu CC, Lai PL, Tan CF, Chen WJ (2004) Intervertebral disc herniation in adolescents. Chang Gung Med J 27:22–28PubMedGoogle Scholar
  60. 60.
    Miralles R, Sanpera I, Fenoll-Brunet MR (1990) Results of operation for lumbar disc protrusions in children. Int Orthop 14:135–138CrossRefPubMedGoogle Scholar
  61. 61.
    Blaauw G, Schaafsma J, Blaauw-Van Dishoeck M (1981) Disk prolapse in the lumbar spine in children and adolescents. Ned Tijdschr Geneeske 125:1404–1407Google Scholar
  62. 62.
    Russwurm H, Bjerkreim I, Ronglan E (1978) Lumbar intervertebral disc herniation in the young. Acta Orthop Scand 49:158–163PubMedCrossRefGoogle Scholar
  63. 63.
    Poussa M, Schlenzka D, Maenpaa S, Merikanto J, Kinnunen P (1997) Disc herniation in the lumbar spine during growth: long-term results of operative treatment in 18 patients. Eur Spine J 6:390–392CrossRefPubMedGoogle Scholar
  64. 64.
    Fisher RG, Saunders RL (1981) Lumbar disc protrusion in children. J Neurosurg 54:480–483CrossRefPubMedGoogle Scholar
  65. 65.
    Loupasis GA, Stamos K, Katonis PG, Sapkas G, Korres DS, Hartofilakidis G (1999) Seven- to 20-year outcome of lumbar discectomy. Spine 24:2313–2317CrossRefPubMedGoogle Scholar
  66. 66.
    Peng XS, Li FB, Pan T, Wan Y, Cheng LY (2002) Traumatic lumbar intervertebral disc herniation in teenagers. Orthop J Chin 9:219–221Google Scholar
  67. 67.
    Frino J, McCarthy RE, Sparks CY, McCullough FL (2006) Trends in adolescent lumbar disk herniation. J Pediatr Orthop 26:579–581PubMedGoogle Scholar
  68. 68.
    Tullberg T, Grane P, Isacson J (1994) Gadolinium-enhanced magnetic resonance imaging of 36 patients one year after lumbar disc resection. Spine 19:176–182PubMedCrossRefGoogle Scholar
  69. 69.
    Papagelopoulos PJ, Peterson HA, Ebersold MJ, Emmanuel PR, Choudhury SN, Quast LM (1997) Spinal column deformity and instability after lumbar or thoracolumbar laminectomy for intraspinal tumors in children and young adults. Spine 22:442–451CrossRefPubMedGoogle Scholar
  70. 70.
    Herring JA, Asher MA (1989) Intervertebral disc herniation in a teenager. J Pediatr Orthop 9:615–617PubMedGoogle Scholar
  71. 71.
    Benifla M, Melamed I, Barrelly R, Aloushin A, Shelef I (2008) Unilateral partial hemilaminectomy for disc removal in a 1-year-old child: case report. J Neurosurg Pediatr 2:133–135CrossRefPubMedGoogle Scholar
  72. 72.
    Martinez-Lage JF, Fernandez Cornejo V, Lopez F, Poza M (2003) Lumbar disc herniation in early childhood: case report and literature review. Child’s Nerv Syst 19:258–260Google Scholar
  73. 73.
    Bartolozzi P, Lombardini G, Floris G (1989) Herniated lumbar disc in the child: a description of two cases. Ital J Orthop Traumatol 15:115–120Google Scholar
  74. 74.
    MacGee EE (1968) Protruded lumbar disc in a 9-year-old boy. J Pediatr 73:418–419CrossRefPubMedGoogle Scholar
  75. 75.
    King AB (1959) Surgical removal of a ruptured intervertebral disc in early childhood. J Pediatr 55:57–62CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.Orthopedic DepartmentPeking University Third HospitalBeijingPeople’s Republic of China

Personalised recommendations