Smorgick Yossi, Floman Yizhar, Millgram Michael A, Anekstein Yoram, Pekarsky Ilya, Mirovsky Yigal
Department of Orthopedic Surgery, Assaf Harofeh Medical Center, Zerifin, 70300, Israel.
Spine J. 2006 Jul-Aug;6(4):380-4. doi: 10.1016/j.spinee.2005.10.015.
Adolescent disc herniation and its surgical treatment have been the subjects of many published clinical series. The majority of these series were heterogeneous; the number of adolescent patients (12-17 years) as opposed to young adults (18-20 years) was generally small and the length of follow-up varied greatly. Although the short-term outcome of disc excision in adolescents was mostly favorable, their long-term outcome is unknown.
To evaluate the mid- and long-term results of discectomy in patients younger than 17 years of age.
Retrospective examination of a series of adolescent patients under the age of 17 years who underwent surgery for lumbar intervertebral disc herniation.
The medical records of 26 patients (15 males, 11 females, 12-17 years old [average 14.6]) who were operated for lumbar intervertebral disc herniation in three spine centers between 1984 and 2002 were reviewed. These subjects represented the total number of patients meeting the criteria of adolescents undergoing discectomy for lumbar disc herniation in these institutions during the study period. All patients were located and contacted by an independent observer not involved in the care of these patients. Low back pain associated with leg pain was the main clinical symptom in 20 patients (77%), leg pain in 4 (15%), and back pain in 2 (8%). They all underwent posterior disc excision: 23 (88%) patients had one level discectomy, and 3 (12%) had simultaneous discectomy at two levels. The L4-L5 interspace was involved 19 times, and the L5-S1 interspace 10 times. Slipped vertebral apophysis was diagnosed in 4 patients (15%). Twelve of the 26 patients (46%) had a first-degree relative with a history of lumbar disc herniation.
Telephone interviews provided follow-up data for 26 patients. Results were classified as excellent, good, moderate, or poor according to current symptom status, the need for additional surgery, the Oswestry Disability Index, and back and leg pain scores.
The average time from surgery to follow-up was 8.9 years (range 3-21 years). At follow-up, the clinical results were excellent in 13 patients (50%), good in 4 (15%), moderate in 8 (31%), and poor in 1 (4%). Four subjects (15%) underwent a subsequent disc excision in the lumbar region, and one of them later underwent fusion.
Discectomy provides satisfactory clinical results in young patients with disc herniation. The rate of reintervention (15%) is comparable to that in adults, indicating that discectomy for young patients should be approached similarly to that in adults.
青少年椎间盘突出症及其手术治疗一直是众多已发表临床系列研究的主题。这些系列研究大多存在异质性；与青年成人（18 - 20岁）相比，青少年患者（12 - 17岁）的数量通常较少，且随访时间差异很大。尽管青少年椎间盘切除术的短期效果大多良好，但其长期效果尚不清楚。
评估17岁以下患者椎间盘切除术的中长期结果。
对一系列17岁以下接受腰椎间盘突出症手术的青少年患者进行回顾性研究。
回顾了1984年至2002年间在三个脊柱中心接受腰椎间盘突出症手术的26例患者（15例男性，11例女性，年龄12 - 17岁[平均14.6岁]）的病历。这些受试者代表了研究期间这些机构中符合青少年腰椎间盘突出症椎间盘切除术标准的患者总数。所有患者均由一名未参与其治疗的独立观察者找到并联系。20例患者（77%）的主要临床症状为下腰痛伴腿痛，4例（15%）为腿痛，2例（8%）为腰痛。他们均接受了后路椎间盘切除术：23例（88%）患者进行了单节段椎间盘切除术，3例（12%）同时进行了两节段椎间盘切除术。L4 - L5间隙受累19次，L5 - S1间隙受累10次。4例患者（15%）诊断为椎体骨骺滑脱。26例患者中有12例（46%）有腰椎间盘突出症病史的一级亲属。
通过电话访谈为26例患者提供随访数据。根据当前症状状态、是否需要额外手术、Oswestry功能障碍指数以及腰腿痛评分，将结果分为优、良、中、差。
手术至随访的平均时间为8.9年（范围3 - 21年）。随访时，13例患者（50%）临床结果为优，4例（15%）为良，8例（31%）为中，1例（4%）为差。4例患者（15%）随后在腰椎区域接受了椎间盘切除术，其中1例后来接受了融合手术。
椎间盘切除术在年轻的椎间盘突出症患者中提供了令人满意的临床结果。再次干预率（15%）与成人相当，这表明对年轻患者的椎间盘切除术应与成人相似。
