Intervertebral Disc Herniation in Adolescents.

Background: The purpose of this study was to review surgery-proven lumbar disc herniationin adolescents with an emphasis on the distinguishing features.Methods: Twenty-eight adolescents between 14 and 18 years old had lumbar discectomyafter conservative treatment for 9 months. Indications for surgery wereintractable pain and failure of conservative treatment for more than 6 weeks.Lumbar spine apophyseal ring fracture was found in 10 of the 24 patients(42%) who had computed tomography studies. Seven patients had piecemealexcision of the fractured apophysis together with the discectomy.Results: All but three patients could raise their leg more than 70 degrees after theoperation. The latest follow-up was conducted an average of 6.1 years aftersurgery. Good or excellent results were noted in 93% of the patients. Twopatients had follow-up operations for recurrent disc herniation and woundinfection.Conclusion: Apophyseal ring fracture was a feature in adolescent disc herniation thatrequires surgical intervention. Early computed tomography study is proposedto detect apophyseal ring lesion, which may lead to failure of conservativetreatment. Excision of the fractured ring apophysis is suggested in addition todiscectomy when the canal space is occupied.