Lumbar disc excisions in patients under the age of 21 years.

Abstract

This study retrospectively analyzed 15 patients in the rarely seen young (under 21 years) age group who had undergone discectomy without fusion for prolapsed (herniated) lumbar disc. The results were analyzed for degree of success in several outcome parameters to relate the efficacy of this patient group/procedure pair to that of other studies. Sixteen operations were performed on this patient group, including six by a conventional procedure and ten by a microsurgical technique. Although most previous studies tend to support the use of discectomy, some physicians have reportedly been reluctant to implement these procedures in young patients. Patients were followed in a short-term (median 3.3 months) assessment using records of post-operative office visits. Long-term (median, 10.5 years) follow-up was done by a mailed, self-report questionnaire that quantified pain in leg and back and scored for degree of success in ability to return to normal activities and satisfaction with the results of surgery. The short-term results were excellent for all but one patient. Long-term follow-up yielded the following successful outcomes: relief of back pain, 77%; and relief of leg pain, return to normal activities, and satisfaction with surgery, each 85%. Despite some tendency to delay discectomy in children and young adults, physicians are urged to be aware of this rare condition and the excellent long-term outcomes and limited complications resulting from timely implementation of discectomy after a failed course of conservative therapy. Moreover, fusion should be avoided except in cases of vertebral instability.