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Tiendrebeogo/Zabsonre WJS, Zabsonre DS, Kabore F, Sanou A, Haro Y, Zoungrana I, Ouedraogo DD. Pediatrics severe low back pain by disc herniation: an uncommon entity. Pediatr Rheumatol Online J 2024; 22:1. [PMID: 38167502 PMCID: PMC10759530 DOI: 10.1186/s12969-023-00942-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Common severe back pain due to disc herniation is rare in the paediatric population which involves children under eighteen years of age. Paediatric lumbar disc herniation (LDH) cannot be considered the same disease as in adults, as it has potentially different natural and clinical backgrounds. The treatment of pediatric LDH is the other particularity of this condition. Indeed, in children, delaying surgery for a conservative treatment is justified. We report 3 cases treated in 8 years. CASE PRESENTATION Three patients, two of whom were 14 years of age and one 17 years of age, were admitted for L5 or S1 lumbosciatica. A CT scan showed a lumbar disc herniation L5S1 associated with bi-isthmic lysis (and a transitional abnormality in 1 case or spina bifida occulta in 1 other case). The last patient had an magnetic resonance imaging (MRI) that showed a herniated L4L5 disc. The diagnosis of low back pain disc herniation was retained in two patients and that of disabling low back disc in one patient. Percutaneous discolysis in the two hyperalgesic cases and epidural corticosteroid infiltration in the disabling case were effective on lumbosciatica. CONCLUSION Paediatric common lomw back pain caused by a disc herniation with a hyperalgic or disabling character posed a therapeutic problem which were solved by the invasive approaches that must be given priority nowadays with children.
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Affiliation(s)
| | | | - Fulgence Kabore
- Rheumatology Department of Bogodogo, University Hospital of Ouagadougou, Karpala, Burkina Faso
| | - Abdoulaye Sanou
- Neurosurgery Department of Yalgado, Ouedraogo University Hospital of Ouagadougou, Karpala, Burkina Faso
| | - Yakouba Haro
- Neurosurgery Department of Yalgado, Ouedraogo University Hospital of Ouagadougou, Karpala, Burkina Faso
| | - Inoussa Zoungrana
- Neurosurgery Department of Yalgado, Ouedraogo University Hospital of Ouagadougou, Karpala, Burkina Faso
| | - Dieu-Donné Ouedraogo
- Rheumatology Department of Bogodogo, University Hospital of Ouagadougou, Karpala, Burkina Faso
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El-Qadi M, Thabit MA, Eissa E, Aziz AAFA, Kamel R. Adolescent Lumbar Intervertebral Disc Herniation: Conservative versus Surgical Treatment. Open Access Maced J Med Sci 2023. [DOI: 10.3889/oamjms.2023.11159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND: Lumbar disc herniation (LDH) in adolescents is relatively a rare condition among those cases presented with low back pain. Trauma and genetics are the most common predisposing factors. Furthermore, the clinical presentations differ from those of the adults. Back pain is not all marked in adolescent patients.
AIM: This study was subjected to discuss the etiology, diagnosis and treatment modalities, and the variable outcomes for both medical and surgical treatment of LDH in adolescents.
PATIENTS AND METHODS: This prospective study was conducted on 20 patients (12 males, eight females) age range 10–19 years presenting with LDH, managed and treated conservatively and/or surgically in Neurosurgery Department at Kasr Al Ainy School of medicine, Cairo University in the period from October 2015 to September 2016 with 12-month follow-up period.
RESULTS: In our study, 12 patients (60%) gave a positive family history, also nine cases (45%) had a history of back trauma before affection with LDH. All the cases (100%) were presented with sciatic pain while only half of them had low back pain, also two cases with motor deficit. After performing magnetic resonance imaging of lumbosacral spine, L5-S1 disc level was the most common level affected. All the patients were subjected to medical treatment which was effective in 40% of the cases and surgical treatment was the only curative method in 12 cases (60%). In this study, the outcome was excellent in 90% of cases where significant to complete relief of pain and significant improvement in the neurological deficits was achieved.
CONCLUSION: Conservative treatment is less effective for adolescent LDH patients as compared with adults, even though it remains the fi rst-line treatment for adolescent LDH.
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Wang Y, Xu Y, Tian G, Dai G. Pediatric lumbar disc herniation: a report of two cases and review of the literature. Eur J Med Res 2022; 27:82. [PMID: 35659297 PMCID: PMC9164894 DOI: 10.1186/s40001-022-00696-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 04/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lumbar disc herniation (LDH) is not a common condition in children. Most reports on pediatric LDH concern the outcomes of surgeries performed in children in whom nonsurgical treatment failed while the outcome of nonsurgical treatment of LDH in children was rarely reported. CASES PRESENTATION Case 1: a 10-year-old girl presented with back pain and sciatica in her left leg for over 3 months. The physical examination revealed exacerbation of back pain by waist extension or flexion, and a positive Lasegue's sign was revealed in her left leg. Magnetic resonance imaging (MRI) revealed lumbar disc herniation at the L5/S1 level. She was diagnosed with LDH. After receiving nonsurgical treatment of traditional Chinese medicine (TCM) for 30 days, the girl had mild low back pain and sciatica and the symptoms had resolved completely at the 3-month follow-up. There was no recurrence within the following 2 years. MRI performed 30 months later revealed that the herniated disc did not shrink significantly. However, she was totally asymptomatic at the follow-up performed 30 months later. Case 2: a 13-year-old boy presented with sciatica in his left leg for over 3 months. The physical examination revealed that Lasegue's sign was positive in the left leg, the level of muscle strength in the left ankle plantar flexors was grade 4. MRI revealed a lumbar disc herniation at the L5/S1 level. He was diagnosed with LDH. The boy underwent 2 weeks of TCM treatment, and exhibited a favorable outcome: only mild pain was noticed in his left buttocks after walking for more than 15 min. He was asymptomatic at the 3-month follow-up and there was no recurrence within the next 3 years. MRI scan performed at 40 months later showed no significant resorption of the herniated disc. However, he was totally asymptomatic at the follow-up performed 40 months later. CONCLUSIONS For the nonsurgical treatment of pediatric LDH, resorption of herniated discs is not necessary for favorable long-term outcomes, and children with symptomatic LDH may become asymptomatic without resorption.
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Affiliation(s)
- Yi Wang
- Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Province Orthopedic Hospital, 132 West First Section First Ring Road, Chengdu, 610041, Sichuan, China.
| | - Yan Xu
- Experiment Teaching Center for Preclinical Medicine, Chengdu Medical College, Xindu District, 783 Xindu Avenue, Chengdu, Sichuan, China
| | - Guogang Tian
- Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Province Orthopedic Hospital, 132 West First Section First Ring Road, Chengdu, 610041, Sichuan, China
| | - Guogang Dai
- Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Province Orthopedic Hospital, 132 West First Section First Ring Road, Chengdu, 610041, Sichuan, China
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Lim WSR, Liow MHL, Goh GS, Yeo W, Ling ZM, Yue WM, Guo CM, Tan SB. Women Do Not Have Poorer Outcomes After Minimally Invasive Lumbar Fusion Surgery: A Five-Year Follow-Up Study. Int J Spine Surg 2020; 14:756-761. [PMID: 33046540 DOI: 10.14444/7108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Women undergoing lumbar spine surgery report greater preoperative pain and disability and have less improvement after surgery. There is a paucity of literature on sex-related differences after minimally invasive surgery transforaminal lumbar interbody fusion (MIS TLIF) surgery. We aim to determine whether sex influences outcome after MIS TLIF at 5-year midterm follow-up. METHODS Prospectively collected registry data for 907 patients who underwent MIS TLIF at a single institution from 2004 to 2013 were reviewed. Of these, 296 patients (94 males and 202 females) were reviewed at 5-year follow-up. All patients were assessed preoperatively and postoperatively at 2 and 5 years. Data recorded included patient demographics, Oswestry Disability Index (ODI), Short-Form 36 Physical and Mental component scores (SF-36 PCS and MCS), and the North American Spine Society lumbar spine outcome assessment instrument. RESULTS Females who underwent MIS TLIF were generally younger (females, 52.2 years; males, 56.1 years; P = .04). Females had significantly poorer preoperative ODI (females, 49.5; males, 41.5; P < .001) and SF-36 PCS (females, 31.9; males, 35.6; P < .01) and MCS (females, 44.9; males, 49.2; P < .01) scores. At 2-year and 5-year follow-up, there were no significant differences in ODI, SF-36, and pain scores between sexes. Both groups reported similar proportions that returned to work and returned to function. There were no differences in proportion of patients who were satisfied or had their expectations fulfilled. CONCLUSIONS Women who undergo MIS TLIF have poorer preoperative function and quality of life than men. However, women demonstrated greater improvement after surgery, attaining similar clinical outcomes at 5-year follow-up. LEVEL OF EVIDENCE 3.
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Affiliation(s)
| | | | - Graham S. Goh
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore
| | - William Yeo
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore
| | | | - Wai-Mun Yue
- The Orthopaedic Centre, Mount Elizabeth Medical Centre, Singapore
| | - Chang Ming Guo
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore
| | - Seang Beng Tan
- Orthopaedic and Spine Clinic, Mount Elizabeth Novena Medical Centre, Singapore
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Beck J, Brisby H, Baranto A, Westin O. Low lordosis is a common finding in young lumbar disc herniation patients. J Exp Orthop 2020; 7:38. [PMID: 32476065 PMCID: PMC7261711 DOI: 10.1186/s40634-020-00253-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/13/2020] [Indexed: 12/27/2022] Open
Abstract
Purpose The sagittal alignment of the lumbar spine and pelvis can be classified into several subtypes. It has been suggested that the risk of developing certain pathologies, such as a lumbar disc herniation (LDH) is affected by spinal sagittal profiles. The main aim of this study was to investigate the sagittal profile in young patients surgically treated for a lumbar disc herniation and if a discectomy would alter the sagittal parameters. Methods Sixteen active young patients (mean age 18.3 ± 3.2 SD) with a lumbar disc herniation having a discectomy were included. A classification according to Roussouly of the sagittal parameters was made by two senior spinal surgeons, both pre-operatively and post-operatively on radiographs. The distribution of sagittal parameters and spinopelvic profiles were analysed and compared to a previous established healthy normal population. Results This series of active young patients with LDH exhibited a low lumbar lordosis dominance, with Roussouly sagittal profiles type 1 and type 2 accounting for more than 75% of the examined patients. An analysis of the erect radiographs revealed no significant changes in the post-operative sagittal profile. Conclusions This study showed that sagittal spinal alignment according to Roussouly in a young population with LDH is skewed compared with a normal population cohort. Furthermore, the lack of post-operative correction is suggestive of a non-ephemeral response to a LDH. Roussouly type 2 spinal sagittal profile may be a risk factor in young individuals suffering a disc herniation.
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Affiliation(s)
- Joel Beck
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, and Sahlgrenska University Hospital, Bruna Straket 11b, S-413 45, Gothenburg, Sweden.
| | - Helena Brisby
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, and Sahlgrenska University Hospital, Bruna Straket 11b, S-413 45, Gothenburg, Sweden
| | - Adad Baranto
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, and Sahlgrenska University Hospital, Bruna Straket 11b, S-413 45, Gothenburg, Sweden
| | - Olof Westin
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, and Sahlgrenska University Hospital, Bruna Straket 11b, S-413 45, Gothenburg, Sweden
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Kobayashi Y, Ogura Y, Kitagawa T, Yonezawa Y, Takahashi Y, Yasuda A, Shinozaki Y, Ogawa J. Gender Differences in Pre- and Postoperative Health-Related Quality of Life Measures in Patients Who Have Had Decompression Surgery for Lumbar Spinal Stenosis. Asian Spine J 2019; 14:238-244. [PMID: 31679323 PMCID: PMC7113473 DOI: 10.31616/asj.2019.0067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/20/2019] [Indexed: 01/02/2023] Open
Abstract
Study Design Retrospective chart audit. Purpose This study aimed to investigate the gender difference in pre- and postoperative health-related quality of life (HRQOL) in patients who have had decompression surgery for lumbar spinal stenosis (LSS). Overview of Literature Gender differences may contribute to variations in disease presentations and health outcomes. The influence of gender on pre- and postoperative HRQOL in spinal disorders remains unclear. Methods We reviewed 125 patients (79 men and 46 women) who had lumbar spinous process splitting laminectomy (LSPSL) for LSS. We assessed the following clinical information: Japanese Orthopedic Association (JOA) score; numerical rating scale (NRS) for low back pain (LBP), leg pain, and leg numbness; Zurich Claudication Questionnaire; JOA Back Pain Evaluation Questionnaire; Roland- Morris Disability Questionnaire (RMDQ); and Short Form 8 (SF-8) as HRQOL. We compared the HRQOLs of men and women pre- and postoperatively. Results Although the preoperative NRS results for LBP were significantly higher in women (p <0.05), there were no significant differences in clinical outcomes between men and women postoperatively. For HRQOL, the RMDQ scores were significantly worse in women preoperatively (p <0.05), but no significant differences were found postoperatively between men and women. Similarly, the SF-8 mental health score was also significantly lower in women preoperatively (p <0.05), but no significant differences were noted between the two groups postoperatively. Conclusions LSPSL greatly reduced LBP, leg pain, and leg numbness in both genders. There were limited differences in pain and several HRQOL questionnaire responses between men and women after surgery. We found that women had greater sensitivity to and/or lower tolerance for pain than men, which led to lower HRQOL mental health scores preoperatively.
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Affiliation(s)
| | - Yoji Ogura
- Spine Center, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | | | - Yoshiro Yonezawa
- Spine Center, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Yohei Takahashi
- Department of Spine and Spinal Cord Surgery, Fujita Health University, Nagoya, Japan
| | - Akimasa Yasuda
- Spine Center, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Yoshio Shinozaki
- Spine Center, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Jun Ogawa
- Spine Center, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
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McAvoy M, McCrea HJ, Chavakula V, Choi H, Bi WL, Mekary RA, Stone S, Proctor MR. Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series. J Neurosurg Pediatr 2019; 24:549-557. [PMID: 31470400 DOI: 10.3171/2019.6.peds18716] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 06/04/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Few studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period. METHODS A retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes. RESULTS Over the 19-year study period, 199 patients underwent LMD at the authors' institution. The mean age at presentation was 16.0 years (range 12-18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion). CONCLUSIONS Microdiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.
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Affiliation(s)
- Malia McAvoy
- 1Division of Health Sciences and Technology, Harvard Medical School, Boston, Massachusetts
- 6Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School; and
| | - Heather J McCrea
- 2Department of Neurosurgery, Holtz Children's Hospital, Nicklaus Children's Hospital, University of Miami Miller School of Medicine, Miami, Florida
| | - Vamsidhar Chavakula
- 3Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Hoon Choi
- 4Department of Neurosurgery, The Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Wenya Linda Bi
- 3Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Rania A Mekary
- 5School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences
- 6Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School; and
| | - Scellig Stone
- 7Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mark R Proctor
- 6Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School; and
- 7Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Raghu ALB, Wiggins A, Kandasamy J. Surgical management of lumbar disc herniation in children and adolescents. Clin Neurol Neurosurg 2019; 185:105486. [DOI: 10.1016/j.clineuro.2019.105486] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/15/2019] [Accepted: 08/08/2019] [Indexed: 11/27/2022]
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Strömqvist F, Strömqvist B, Jönsson B, Karlsson MK. Surgical treatment of lumbar disc herniation in different ages-evaluation of 11,237 patients. Spine J 2017; 17:1577-1585. [PMID: 28336482 DOI: 10.1016/j.spinee.2017.03.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/10/2017] [Accepted: 03/15/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Surgical treatment of lumbar disc herniation (LDH) may lead to different outcomes in young, middle-aged, and elderly patients. However, no study has, by the same data ascertainment, evaluated referral pattern, improvement, and outcome in different age strata. PURPOSE This study aimed to evaluate referral pattern and outcome in patients of different ages surgically treated because of LDH. STUDY DESIGN This is a register study of prospectively collected data. PATIENT SAMPLE In SweSpine, the national Swedish register for spinal surgery, we identified 11,237 patients who between 2000 and 2010 had their outcome of LDH surgery registered in pre-, per-, and 1-year postoperative evaluations. OUTCOME MEASURES The data collected included age, gender, smoking habits, walking distance, preoperative duration and degree of back and leg pain, consumption of analgesics, quality of life in the patient-reported outcome measure (PROM) Short-Form 36 (SF-36) and EuroQol 5 dimensions (EQ5D), disability in the Oswestry Disability Index, operated level, type of surgery, and complications. METHODS We compared the outcome in patients within different 10-year age strata. IBM SPSS Statistics 22 was used in the statistical calculations. No funding was obtained for this study. The authors have no conflicts of interest to declare. RESULTS Patients in all ages referred to surgery had inferior PROM data compared with published normative age-matched PROM data. Referral to LDH surgery demanded of each 10-year strata statistically significantly more pain, lower quality of life, and more disability (all p<.001). Surgery markedly improved quality of life and reduced disability in all age groups (all p<.001), but with statistically significantly less PROM improvement with each older 10-year strata (all p<.001). This resulted in statistically significantly inferior PROM values for pain, quality of life, and disability postoperatively for each 10-year strata (all p<.001). There were also more complications (p<.001) with each 10-year older strata. CONCLUSIONS In general, older patients referred to LDH surgery have statistically significantly inferior PROM scores, improve less, and reach inferior PROM scores postoperatively. The clinical relevance must however be questioned because most patients reach, independent of age group, the defined level for a successful outcome, and the patient satisfaction rate is high.
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Affiliation(s)
- Fredrik Strömqvist
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö SE-205 02, Sweden; Clinical and Molecular Osteoporosis Research Unit, Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö SE-205 02, Sweden.
| | - Björn Strömqvist
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö SE-205 02, Sweden; Clinical and Molecular Osteoporosis Research Unit, Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö SE-205 02, Sweden
| | - Bo Jönsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö SE-205 02, Sweden; Clinical and Molecular Osteoporosis Research Unit, Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö SE-205 02, Sweden
| | - Magnus K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö SE-205 02, Sweden; Clinical and Molecular Osteoporosis Research Unit, Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö SE-205 02, Sweden
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Abstract
Lower back pain in young athletes is a common problem. The prevalence of back pain from different causes in adolescent age group is between 20% and 30%. However, the incidence of low back pain in young athletes varies widely in different sports. Overuse injuries are the most common cause of low back pain in young athletes. In case of overuse injuries, the cause and effect relationship between back pain and specific condition is often difficult to establish. In adolescent athletes, the most common underlying identified cause of low back pain is lumbar spondylolysis. During adolescent growth spurt, the severity of the pain generally correlates with adolescent growth spurt. Participation in sports starting at an early age and for a longer duration tends to increase the risk for back pain. Numerous conditions cause low back pain in athletes. These include acute trauma, chronic overuse or repetitive trauma, and referred pain. Our focus in here will be on selected conditions that cause recurrent or chronic low back pain.
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Affiliation(s)
- Dilip R Patel
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Elizabeth Kinsella
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
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Rabbitts JA, Fisher E, Rosenbloom BN, Palermo TM. Prevalence and Predictors of Chronic Postsurgical Pain in Children: A Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2017; 18:605-614. [PMID: 28363861 PMCID: PMC5457338 DOI: 10.1016/j.jpain.2017.03.007] [Citation(s) in RCA: 173] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/06/2017] [Accepted: 03/12/2017] [Indexed: 11/28/2022]
Abstract
Emerging research suggests that pain may persist longer-term for many children after major surgery, with significant effects on their health outcomes. This systematic review identified the prevalence of chronic postsurgical pain (CPSP) in children after surgery, and determined presurgical biomedical and psychosocial risk factors associated with CPSP prevalence or severity. Prospective studies assessing CPSP 3 to 12 months after surgery in children 6 to 18 years of age published in English in MedLine, EMBASE, PsycINFO, and Cochrane Database of Systematic Reviews since 1996 were eligible for inclusion. Of 16,084 abstracts yielded by the search, 123 full articles were assessed for eligibility, and 12 studies were included in the review. Overall quality of included studies assessed using the Quality in Prognostic Studies tool was low. On the basis of 4 studies with a total of 628 participants across all surgery types, median prevalence of CPSP across studies was 20% (25th percentile = 14.5%, 75th percentile = 38%) at 12 months after surgery. Presurgical pain intensity, child anxiety, child pain coping efficacy, and parental pain catastrophizing were the only presurgical factors identified as predictive of CPSP. Biological and medical factors assessed were not associated with CPSP in any study. Well designed studies examining prevalence and predictors of CPSP are critically needed in children. PERSPECTIVE In this systematic review, the median prevalence of CPSP in children was 20% across studies. Presurgical pain intensity, and child and parent psychosocial factors predicted CPSP. Additional resources and interventions are needed for youth who report persistent pain after surgery.
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Affiliation(s)
- Jennifer A Rabbitts
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington; Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington.
| | - Emma Fisher
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Brittany N Rosenbloom
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington; Department of Psychology, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Tonya M Palermo
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington; Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
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Gulati S, Madsbu MA, Solberg TK, Sørlie A, Giannadakis C, Skram MK, Nygaard ØP, Jakola AS. Lumbar microdiscectomy for sciatica in adolescents: a multicentre observational registry-based study. Acta Neurochir (Wien) 2017; 159:509-516. [PMID: 28091818 PMCID: PMC5306165 DOI: 10.1007/s00701-017-3077-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/04/2017] [Indexed: 11/28/2022]
Abstract
Background Lumbar disc herniation (LDH) is rare in the adolescent population. Factors predisposing to LDH in adolescents differ from adults with more cases being related to trauma or structural malformations. Further, there are limited data on patient-reported outcomes after lumbar microdiscectomy in adolescents. Our aim was to compare clinical outcomes at 1 year following single-level lumbar microdiscectomy in adolescents (13–19 years old) compared to younger adults (20–50 years old) with LDH. Methods Data were collected through the Norwegian Registry for Spine Surgery. Patients were eligible if they had radiculopathy due to LDH, underwent single-level lumbar microdiscectomy between January 2007 and May 2014, and were between 13 and 50 years old at time of surgery. The primary endpoint was change in Oswestry Disability Index (ODI) 1 year after surgery. Secondary endpoints were generic quality of life (EuroQol five dimensions [EQ-5D]), back pain numerical rating scale (NRS), leg pain NRS and complications. Results A total of 3,245 patients were included (97 patients 13–19 years old and 3,148 patients 20–50 years old). A significant improvement in ODI was observed for the whole population, but there was no difference between groups (0.6; 95% CI, −4.5 to 5.8; p = 0.811). There were no differences between groups concerning EQ-5D (−0.04; 95% CI, −0.15 to 0.07; p = 0.442), back pain NRS (−0.4; 95% CI, −1.2 to 0.4; p = 0.279), leg pain NRS (−0.4; 95% CI, −1.2 to 0.5; p = 0.374) or perioperative complications (1.0% for adolescents, 5.1% for adults, p = 0.072). Conclusions The effectiveness and safety of single-level microdiscectomy are similar in adolescents and the adult population at 1-year follow-up.
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Mulholland RC. The Michel Benoist and Robert Mulholland yearly European Spine Journal Review: a survey of the "surgical and research" articles in the European Spine Journal, 2016. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:11-19. [PMID: 28062915 DOI: 10.1007/s00586-016-4942-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 11/18/2016] [Indexed: 11/28/2022]
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Tschugg A, Löscher WN, Lener S, Wildauer M, Hartmann S, Neururer S, Thomé C. Gender differences after lumbar sequestrectomy: a prospective clinical trial using quantitative sensory testing. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:857-864. [PMID: 28004244 DOI: 10.1007/s00586-016-4891-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 10/17/2016] [Accepted: 11/17/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Quantitative sensory testing (QST) gained popularity to evaluate the time course of recovery in sensory dysfunction and the results of different treatment options. Concerning sex differences in lumbar spine surgery, female gender seems to play a major role as a negative prognostic factor in different spinal disorders. For this purpose, we hypothesised that there are also comparable differences in pain patterns in men and women after lumbar sequestrectomy using QST. METHODS We applied the QST protocol of the German Research Network on Neuropathic Pain in 53 patients (21 women and 32 men) with a single lumbar disc herniation confirmed on MRI treated by a lumbar sequestrectomy. Further evaluation included a detailed medical history, a physical examination, and various questionnaires: Beck-Depression-Inventory, Oswestry Disability Index, Core Outcome Measure Index, painDETECT-Questionnaire and EQ-5D thermometer. RESULTS Our analyses showed lower heat thresholds in females preoperatively, that adjusted to that of males 1 week postoperatively. Pressure pain thresholds were lower in women as well, but differed between genders throughout the study. Vibration perception deficits resolve earlier in female than in male patients. Both, women and men, had an excellent overall improvement, postoperatively. CONCLUSION Our results clearly revealed pre- and postoperative differences in pain perception between genders. These differences have to be taken into account in the evaluation of outcome between genders. Therefore, QST seems to be a good method to evaluate the time course of recovery after surgery.
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Affiliation(s)
- Anja Tschugg
- Departmen of Neurosurgery, Innsbruck Medical University, Anichstr. 35, 6020, Innsbruck, Austria.
| | - Wolfgang N Löscher
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Sara Lener
- Departmen of Neurosurgery, Innsbruck Medical University, Anichstr. 35, 6020, Innsbruck, Austria
| | - Matthias Wildauer
- Department of Neuroradiology, Innsbruck Medical University, Innsbruck, Austria
| | - Sebastian Hartmann
- Departmen of Neurosurgery, Innsbruck Medical University, Anichstr. 35, 6020, Innsbruck, Austria
| | - Sabrina Neururer
- Department of Medical Statistics and Health Economics, Innsbruck Medical University, Innsbruck, Austria
| | - Claudius Thomé
- Departmen of Neurosurgery, Innsbruck Medical University, Anichstr. 35, 6020, Innsbruck, Austria
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