Tuesday, May 3, 2022

 Blog Topic: Disc herniation/Bulges in adolescents and how to treat



So, the symptoms of lumbar disc problems and the cause symptoms (pressure against nerve roots) are similar between adults and adolescents. 

What is different?

In adults the pressure is created by a dehydrated (lack of water) or a bad disc herniates through the posterior ligament in adults

In adolescents the growth plate on the vertebral body (called ring apophysis) fractures and pushes backwards.

So what are the available treatments for adolescents? There are two main groups:

·        Nonoperative

o   Rest (short-term only)

o   Analgesics (pain medications)

o   Physiotherapy: Paraspinal and Core strengthening, aerobic conditioning

o   Spinal injections: epidural and selective nerve root

o   What do I not recommend:

§  Chiropractic manipulation

§  Bracing (weakens back and core muscles)

·        Operative/Surgical: Microdiscectomy


Some important facts:

+ Nonoperative treatment listed above is almost ALWAYS the first step in care.  This is because most ring apophyseal injuries are minor, heal and don’t cause long-term problems.

+ Persistent numbness and weakness require more urgent treatment and more frequently need early surgery.

+ There is no hurry to do surgery (from a surgeon standpoint) when there is only pain down the leg +/- back pain.  Surgery appears to be helpful in relieving leg pain even if done late.

+ Selective nerve root injections can be diagnostic and therapeutic.  Even temporary symptom improvement is important as it can help identify the cause of the back/leg pain.

+ Microdiscectomies do a good job of improving leg pain, but not a good job of alleviating back pain.


When should I consider an Operative/Surgical Microdiscectomy?

If nonoperative treatments have failed to adequately alleviate leg pain

There is a ring apophseal fracture or disc herniation on MRI

Selective Nerve Root Injections confirm pain generator, even if only temporary relief

Discussions with your surgeon determine the pain generator is the disc and no other nonoperative options remain which could help.

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