Ishihara H, Matsui H, Hirano N, Tsuji H
Department of Orthopaedic Surgery, Toyama Medical and Pharmaceutical University, Japan.
Spine (Phila Pa 1976). 1997 Sep 1;22(17):2044-9. doi: 10.1097/00007632-199709010-00022.
In this retrospective study, the long-term clinical results of lumbar intervertebral disc herniation in children less than 16 years of age were reviewed.
To evaluate the effectiveness of surgical treatment including posterior discectomy, extraperitoneal anterolateral discectomy, and anterior interbody fusion for lumbar intervertebral disc herniation in children less than 16 years of age.
Although previous follow-up studies on surgically managed lumbar intervertebral disc herniation in children and adolescents generally reveal good outcomes, few reports have focused on the time course of clinical findings and the long-term results.
The outcome of subjective symptoms, clinical signs, and time-related change of the intervertebral disc space in 11 patients were evaluated with an average follow-up period of 9 years (range, 5-12 years).
The posterior discectomy procedure relieved clinical symptoms quickly. In the case of central herniation with or without intervertebral instability, extraperitoneal anterolateral discectomy or anterior interbody fusion led to favorable long-term results. Clinical symptoms (lower back pain, leg pain) and neurologic disturbance disappeared within 3 months after surgery. Recovery of normal straight leg raising test results (tight hamstrings), however, required much more time than recovery of other symptoms. Narrowing of the intervertebral disc space progressed up to 3-6 months after discectomy, but then disc space widening occurred.
Satisfactory long-term clinical results and early return to school life were obtained with each surgical procedure. It is important to aim toward an early return to school via surgical treatment.
在这项回顾性研究中，对16岁以下儿童腰椎间盘突出症的长期临床结果进行了回顾。
评估包括后路椎间盘切除术、腹膜外前外侧椎间盘切除术和前路椎间融合术在内的手术治疗对16岁以下儿童腰椎间盘突出症的有效性。
尽管先前关于儿童和青少年手术治疗腰椎间盘突出症的随访研究总体显示出良好的结果，但很少有报告关注临床发现的时间进程和长期结果。
对11例患者的主观症状、临床体征和椎间盘间隙的时间相关变化结果进行评估，平均随访期为9年（范围5 - 12年）。
后路椎间盘切除术能迅速缓解临床症状。对于伴有或不伴有椎间不稳定的中央型突出，腹膜外前外侧椎间盘切除术或前路椎间融合术可带来良好的长期效果。临床症状（下腰痛、腿痛）和神经功能障碍在术后3个月内消失。然而，直腿抬高试验结果恢复正常（腘绳肌紧张）所需的时间比其他症状恢复所需的时间长得多。椎间盘切除术后椎间盘间隙变窄会持续3至6个月，但随后会出现椎间盘间隙增宽。
每种手术方法都取得了令人满意的长期临床结果，且患者能早期重返校园生活。通过手术治疗争取早期重返校园很重要。
