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.