Recovery Trajectory and Long-Term Outcomes After Lumbar Microdiscectomy in Adolescents: A 5-Year Longitudinal Study.

Abstract

Symptomatic lumbar disc herniation (LDH) requiring surgery is uncommon in adolescents, and available outcome data are limited compared with adult populations. Although lumbar microdiscectomy is generally associated with favorable short-term results, information regarding the long-term durability of clinical improvement and the trajectory of recovery in this age group remains scarce. The purpose of this study was to evaluate long-term patient-reported outcomes and recovery patterns following lumbar microdiscectomy for adolescent LDH. A retrospective analysis of prospectively collected data was performed for consecutive patients between 14 and 18 years old who underwent microdiscectomy for symptomatic LDH refractory to ≥6 weeks of conservative treatment. Pain (VAS leg/back), disability (ODI), and quality of life (EQ-5D) were assessed preoperatively and at 1, 3, 6, and 12 months and at a minimum of 60 months postoperatively. Longitudinal changes were analyzed using linear mixed-effects models with Holm-adjusted comparisons versus baseline. Complications and reoperations were recorded. Twenty-six adolescents (mean age 15.7±1.8 y) with complete ≥60-month follow-up were included. Significant improvement was observed for all outcomes (P<0.001). Mean VAS leg pain improved from 8.3 to 1.2 and VAS back pain from 6.0 to 1.0 at final follow-up. ODI improved from 61.8 to 12.9, and EQ-5D increased from 0.456 to 0.942. The greatest improvement occurred within the first 3 to 6 months and remained stable thereafter. No perioperative complications were observed. Two patients (8%) required reoperation for recurrent herniation. Lumbar microdiscectomy provides rapid and durable clinical improvement in adolescents with LDH. Most recovery occurs early and remains stable through 5 years, supporting microdiscectomy as a reliable treatment option in appropriately selected patients. Level IV-therapeutic study (retrospective case series of prospectively collected data).