Percutaneous endoscopic interlaminar discectomy for pediatric lumbar disc herniation



Percutaneous endoscopic interlaminar discectomy (PEID) is a widely used minimally invasive procedure which shows satisfying outcomes in the adult population. However, pediatric lumbar disc herniations (PLDH) occur in growing spines and are less related to degeneration, which makes them different from the adult disc herniations. This study evaluates the clinical outcomes of PEID in treating PLDH.


A prospect study was done in the period from June 2010 to December 2012, which included 29 consecutive pediatric patients with a mean age of 16.4 years (range, 13 to 18 years) who underwent PEID for single level lumbar disc herniation. The following measuring tools were used: visual analog scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and Macnab criteria.


There were no severe complications such as dural tear or nerve root damage found in our study. The mean follow-up period was 19.7 months. The VAS score for leg and back pain decreased dramatically at 1 day postoperatively and kept decreasing until the follow-up visit at 3 months postoperatively, when it became stable at a low level. ODI kept improving until the follow-up visit at 6 months postoperatively when it reached a stable low level. Of the patients, 91 % reported no longer having leg pain and 9 % had occasional leg pain at last follow-up.


PEID shows a satisfying outcome with a minimal rate of complications. It has the advantages of minimal traumatization and scar formation and is a safe and effective treatment for PLDH.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4


  1. 1.

    Ahn Y, Kim CH, Lee JH, Lee SH, Kim JS (2013) Radiation exposure to the surgeon during percutaneous endoscopic lumbar discectomy: a prospective study. Spine 38(7):617–625. doi:10.1097/BRS.0b013e318275ca58

    PubMed  Article  Google Scholar 

  2. 2.

    Aizawa T, Ozawa H, Kusakabe T, Nakamura T, Sekiguchi A, Takahashi A, Sasaji T, Tokunaga S, Chiba T, Morozumi N, Koizumi Y, Itoi E (2012) Reoperation for recurrent lumbar disc herniation: a study over a 20-year period in a Japanese population. J Orthop Sci 17(2):107–113

    PubMed  Article  Google Scholar 

  3. 3.

    Choi G, Lee SH, Raiturker PP, Lee S, Chae YS (2006) Percutaneous endoscopic interlaminar discectomy for intracanalicular disc herniations at L5-S1 using a rigid working channel endoscope. Neurosurgery 58 (1 Suppl):ONS59-68; discussion ONS59-68

  4. 4.

    Fairbank JC, Pynsent PB (2000) The Oswestry Disability Index. Spine 25(22):2940–2952, discussion 2952

    CAS  PubMed  Article  Google Scholar 

  5. 5.

    Gennuso R, Humphreys RP, Hoffman HJ, Hendrick EB, Drake JM (1992) Lumbar intervertebral disc disease in the pediatric population. Pediatr Neurosurg 18(5–6):282–286

    CAS  PubMed  Article  Google Scholar 

  6. 6.

    Grobler LJ, Simmons EH, Barrington TW (1979) Intervertebral disc herniation in the adolescent. Spine 4(3):267–278

    CAS  PubMed  Article  Google Scholar 

  7. 7.

    Haeusler M, Schiess R, Boeni T (2013) Evidence for juvenile disc herniation in a homo erectus boy skeleton. Spine 38(3):E123–E128. doi:10.1097/BRS.0b013e31827cd245

    PubMed  Article  Google Scholar 

  8. 8.

    Haidar R, Ghanem I, Saad S, Uthman I (2010) Lumbar disc herniation in young children. Acta Paediatr 99(1):19–23. doi:10.1111/j.1651-2227.2009.01460.x

    CAS  PubMed  Google Scholar 

  9. 9.

    Hoogland T, Schubert M, Miklitz B, Ramirez A (2006) Transforaminal posterolateral endoscopic discectomy with or without the combination of a low-dose chymopapain: a prospective randomized study in 280 consecutive cases. Spine 31(24):E890–E897. doi:10.1097/01.brs.0000245955.22358.3a

    PubMed  Article  Google Scholar 

  10. 10.

    Kim CH, Chung CK (2012) Endoscopic interlaminar lumbar discectomy with splitting of the ligament flavum under visual control. J Spinal Disord Tech 25(4):210–217

    PubMed  Article  Google Scholar 

  11. 11.

    Kim JS, Choi G, Lee SH (2011) Percutaneous endoscopic lumbar discectomy via contralateral approach: a technical case report. Spine 36(17):E1173–E1178. doi:10.1097/BRS.0b013e3182264458

    PubMed  Article  Google Scholar 

  12. 12.

    Kwon DW, Kim KH, Park JY, Chin DK, Kim KS, Cho YE, Kuh SU (2013) Clinical outcomes and considerations of the lumbar interbody fusion technique for lumbar disk disease in adolescents. Child’s Nerv Syst ChNS Off J Int Soc Pediatr Neurosurg 29(8):1339–1344. doi:10.1007/s00381-013-2088-6

    Article  Google Scholar 

  13. 13.

    Lavelle WF, Bianco A, Mason R, Betz RR, Albanese SA (2011) Pediatric disk herniation. J Am Acad Orthop Surg 19(11):649–656

    PubMed  Google Scholar 

  14. 14.

    Matsui HKH, Kawaguchi Y, Tsuji H (1995) Physiological changes of nerve root during posterior lumbar discectomy. Spine 20:654–659

    CAS  PubMed  Article  Google Scholar 

  15. 15.

    Matsui H, Ohmori K, Kanamori M, Ishihara H, Tsuji H (1998) Significance of sciatic scoliotic list in operated patients with lumbar disc herniation. Spine 23(3):338–342

    CAS  PubMed  Article  Google Scholar 

  16. 16.

    Nellensteijn J, Ostelo R, Bartels R, Peul W, van Royen B, van Tulder M (2010) Transforaminal endoscopic surgery for symptomatic lumbar disc herniations: a systematic review of the literature. Eur Spine J 19(2):181–204

    PubMed Central  PubMed  Article  Google Scholar 

  17. 17.

    Ozgen S, Konya D, Toktas OZ, Dagcinar A, Ozek MM (2007) Lumbar disc herniation in adolescence. Pediatr Neurosurg 43(2):77–81. doi:10.1159/000098377

    PubMed  Article  Google Scholar 

  18. 18.

    Parisini P, Di Silvestre M, Greggi T, Miglietta A, Paderni S (2001) Lumbar disc excision in children and adolescents. Spine 26(18):1997–2000

    CAS  PubMed  Article  Google Scholar 

  19. 19.

    Patel AA, Spiker WR, Daubs M, Brodke D, Cannon-Albright LA (2011) Evidence for an inherited predisposition to lumbar disc disease. J Bone Joint Surg Am 93(3):225–229

    PubMed Central  PubMed  Article  Google Scholar 

  20. 20.

    Ruetten S, Komp M, Godolias G (2006) A new full-endoscopic technique for the interlaminar operation of lumbar disc herniations using 6-mm endoscopes: prospective 2-year results of 331 patients. Minim Invasive Neurosurg 49(2):80–87

    CAS  PubMed  Article  Google Scholar 

  21. 21.

    Ruetten S, Komp M, Merk H, Godolias G (2008) Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine 33(9):931–939

    PubMed  Article  Google Scholar 

  22. 22.

    Ruetten S, Komp M, Merk H, Godolias G (2009) Recurrent lumbar disc herniation after conventional discectomy: a prospective, randomized study comparing full-endoscopic interlaminar and transforaminal versus microsurgical revision. J Spinal Disord Tech 22(2):122–129

    PubMed  Article  Google Scholar 

  23. 23.

    Ruetten S, Komp M, Merk H, Godolias G (2009) Surgical treatment for lumbar lateral recess stenosis with the full-endoscopic interlaminar approach versus conventional microsurgical technique: a prospective, randomized, controlled study. J Neurosurg Spine 10(5):476–485

    PubMed  Article  Google Scholar 

  24. 24.

    Slotkin JR, Mislow JM, Day AL, Proctor MR (2007) Pediatric disk disease. Neurosurg Clin N Am 18(4):659–667. doi:10.1016/

    PubMed  Article  Google Scholar 

  25. 25.

    Wahren H (1945) Herniated nucleus pulposus in a child of twelve years. Acta Orthop Scand 16(1):40–42

    CAS  PubMed  Article  Google Scholar 

  26. 26.

    Yeung AT, Tsou PM (2002) Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine 27(7):722–731

    PubMed  Article  Google Scholar 

  27. 27.

    Yorimitsu E, Chiba K, Toyama Y, Hirabayashi K (2001) Long-term outcomes of standard discectomy for lumbar disc herniation: a follow-up study of more than 10 years. Spine 26(6):652–657

    CAS  PubMed  Article  Google Scholar 

Download references


The authors thank the Special Scientific Research Project of Health Industry (201002018): Early Intervention, Standard Diagnosis and Treatment of Chronic Spinal Degenerative Diseases and Deformities for the financial supporting.

Conflict of interest


Author information



Corresponding author

Correspondence to Jiancheng Zeng.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Wang, X., Zeng, J., Nie, H. et al. Percutaneous endoscopic interlaminar discectomy for pediatric lumbar disc herniation. Childs Nerv Syst 30, 897–902 (2014).

Download citation


  • Lumbar disc herniation
  • Pediatric
  • Treatment
  • Percutaneous
  • Endoscopic interlaminar discectomy