Musa Gerald, Namonje Wila, Simfukwe Keith, Familia Karina Marisel, Mwela Bupe Mumba, Ndandja Dimitri T K, Ramirez Manuel De Jesus Encarnacion, Chilawa Samuel, Sichizya Kachinga Agrippa, Chikoya Laston, Chmutin Gennady E, Demetriades Andreas K
Department Surgery, Neurosurgery Unit, Livingstone Teaching Hospital, Livingstone, Zambia.
Department of Neurological Disease and Neurosurgery, Peoples Friendship University of Russia Named After Patrice Lumumba (RUDN), Moscow, Russia.
J Craniovertebr Junction Spine. 2025 Jan-Mar;16(1):34-40. doi: 10.4103/jcvjs.jcvjs_3_25. Epub 2025 Apr 1.
Pediatric lumbar disc herniation (LDH) presents unique challenges compared to adult cases due to anatomical and developmental differences in the spine. This systematic review aims to consolidate evidence on the management and outcomes of pediatric LDH.
What are the clinical outcomes and efficacy of conservative and surgical treatments for pediatric LDH?
A systematic review of studies from 2010 to 2024 was conducted following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Databases including PubMed, Embase, Scopus, and Cochrane Library were searched for studies reporting on pediatric LDH treatment outcomes. Pain, disability, recurrence, and complication rates were extracted and assessed. The Joanna Briggs Institute checklist was used to evaluate bias.
The review included 861 pediatric patients across 14 studies, with a mean age of 14.88 years and a male predominance (59.6%). The most commonly affected levels were L5/S1 (53%) and L4/L5 (43.8%). Conservative treatment was employed in 9.9% (n = 66), whereas microdiscectomy, endoscopic discectomy, and fusion were performed in 53.7% (n = 360), 32.2% (n = 216), 4.2% (n = 28), respectively. Postoperatively, improvements in pain (Visual Analog Scale: 6.15-1.33) and disability (Oswestry Disability Index: 42.09-7.01) were noted. The recurrence rate was 1.7% postoperatively and 42.4% following conservative management (average follow-up period of 23.78 months). Complication rate was 3%.
Pediatric LDH is primarily associated with sports-related trauma. Minimally invasive techniques such as endoscopic and microdiscectomy demonstrate good early and long-term outcomes, and low complications and recurrence rates. There is a paucity of studies comparing management techniques, particularly ones discussing conservative management, which may represent underreporting.
由于脊柱的解剖和发育差异，小儿腰椎间盘突出症（LDH）与成人病例相比面临着独特的挑战。本系统评价旨在整合有关小儿LDH治疗和结局的证据。
小儿LDH保守治疗和手术治疗的临床结局及疗效如何？
按照系统评价和Meta分析的首选报告项目指南，对2010年至2024年的研究进行了系统评价。在包括PubMed、Embase、Scopus和Cochrane图书馆在内的数据库中搜索报告小儿LDH治疗结局的研究。提取并评估疼痛、残疾、复发和并发症发生率。使用乔安娜·布里格斯研究所清单评估偏倚。
该评价纳入了14项研究中的861例小儿患者，平均年龄为14.88岁，男性占优势（59.6%）。最常受累的节段是L5/S1（53%）和L4/L5（43.8%）。9.9%（n = 66）采用了保守治疗，而分别有53.7%（n = 360）、32.2%（n = 2佃）、4.2%（n = 28）进行了显微椎间盘切除术、内镜下椎间盘切除术和融合术。术后，疼痛（视觉模拟评分：6.15 - 1.33）和残疾（奥斯威斯残疾指数：42.09 - 7.01）有改善。术后复发率为1.7%，保守治疗后为42.4%（平均随访期23.78个月）。并发症发生率为3%。
小儿LDH主要与运动相关创伤有关。内镜和显微椎间盘切除术等微创技术显示出良好的早期和长期结局，以及低并发症和复发率。比较治疗技术的研究较少见，尤其是讨论保守治疗的研究，这可能意味着报告不足。
