Blog Topic: Disc herniation/Bulges in adolescents, and how they differ than those in adults.

4-7-2022

 

When talking about a new topic, I have tended to go into significant detail about the basics of the problem to be discussed.  However, after review of the below webpage from the American Academy of Orthopaedic Surgeons (AAOS) I don’t think I can do a better, more thorough explanation of the anatomy, pathology, diagnosis and treatment of disc herniations in adults.  Therefore, I will encourage you to use this hyperlink:

https://orthoinfo.aaos.org/en/diseases--conditions/herniated-disk-in-the-lower-back/

Alternatively, try this link to OrthoBullets:

https://www.orthobullets.com/spine/2035/lumbar-disc-herniation

 

Like many problems in the musculoskeletal system, there can be significant differences between adolescents and adults, from presentation, to diagnosis, treatment and the short- and long-term outcomes.  Therefore, before we discuss the differences let us present some of the commonalities between adolescents and adults:

• ·        Symptoms of low back pain, leg/hip numbness and pain and leg muscle weakness are similar. 
• ·        Nerve root pain is caused by the disc material compressing the nerve root.
• ·        Both typically have a more acute onset of back and leg pain symptoms, often related to a twisting/bending motion.

 

So what are the differences between adolescents and adults?

• ·        “Arthritis” is common in adults and uncommon in adolescents. 
• ·        Disc degeneration is required for a disc herniation in adults and often there are multiple levels which have degenerative discs.  “Only bad discs herniate”.
• ·        In adolescents, disc degeneration sometimes is seen on MRI. 
• ·        In adults, a piece of the degenerated disc is extruded backwards against the nerve roots (see below diagram).  In adolescents the small growth plate on the vertebra separates and this piece of bone and the attached soft tissues move backwards against the nerve roots (see below diagram).

In Adolescents: In the below diagram of the spine the normal ring apophysis (at green arrow) is a growth center in the developing spine and is a weak link when twisting and bending forces are placed onto the spine.  If overloaded, the ring fracture is pulled off the vertebra (black arrow) and moves toward the spinal canal (the area in blue).

 

In Adults: When the nerve root exits the spinal canal (green arrow) there is plenty of room without any areas of compression.  When the disc degenerates it will push a piece of the disc into the spinal canal and against the nerve root (red arrows) which can cause leg pain and numbness and muscle weakness in the leg.