- Diff Dx: slipped vertebral apophysis
- Discussion:
- disc herniation is uncommon in children;
- herniations are most common at the disc spaces between the fourth and
fifth
lumbar vertebrae & between 5th lumbar and 1st sacral vertebrae;
- Clinical Findings:
- children experience little or no back pain, but sciatica is common;
- positive
straight-leg-raise test is most common clinical finding
- back pain is typically increased by activity & relieved by rest;
- neurological symptoms or findings are uncommon;
- Radiographs:
- plain x-rays are usually normal;
- disc-space narrowing is uncommon;
- look for associated congenital anomalies in the lumbosacral area:
- transitional vertebrae;
-
Spinal Stenosis
-
Spina Bifida;
- lateral recess stenosis (CT);
- herniated disc can be dx'ed w/ MRI studies, CT scans, or myelography;
- Treatment:
- initial treatment involves conservative management, including restriction of
activities, bed rest, & administration of analgesic medication;
- if there is no relief of pain, or if there are persistent neurological
symptoms, consider operative intervention;
- this is esp true when there are associated congenital anomalies;
Lumbar disc herniation in children.
