Yonsei Med J.  2005 Feb;46(1):125-132. 10.3349/ymj.2005.46.1.125.

Surgical Treatments for Lumbar Disc Disease in Adolescent Patients; Chemonucleolysis / Microsurgical Discectomy/ PLIF with Cages

• Kuh SU
• Kim YS
• Cho YE
• Yoon YS
• Jin BH
• Kim KS
• Chin DK

• KMID: 2158122
• DOI: http://doi.org/10.3349/ymj.2005.46.1.125

Abstract

The herniated lumbar disc (HLD) in adolescent patients is characterized by typical discogenic pain that originates from a soft herniated disc. It is frequently related to back trauma, and sometimes it is also combined with a degenerative process and a bony spur such as posterior Schmorl's node. Chemonucleolysis is an excellent minimally invasive treatment having these criteria: leg pain rather than back pain, severe limitation on the straight leg raising test (SLRT), and soft disc protrusion on computed tomography (CT). Microsurgical discectomy is useful in the cases of extruded or sequestered HLD and lateral recess stenosis due to bony spur because the nerve root is not decompressed with chymopapain. Spinal fusion, like as PLIF, should be considered in the cases of severe disc degeneration, instability, and stenosis due to posterior central bony spur. In our study, 185 adolescent patients, whose follow-up period was more than 1 year (the range was 1 - 4 years), underwent spinal surgery due to HLD from March, 1998 to December, 2002 at our institute. Among these cases, we performed chemonucleolysis in 65 cases, microsurgical discectomy in 94 cases, and posterior lumbar interbody fusion (PLIF) with cages in 33 cases including 7 reoperation cases. The clinical success rate was 91% for chemonucleolysis, 95% for microsurgical disectomy, and 89% for PLIF with cages, and there were no non- union cases for the PLIF patients with cages. In adolescent HLD, chemonucleolysis was the 1st choice of treatment because the soft adolescent HLD was effectively treated with chemonucleolysis, especially when the patient satisfied the chemonucleolysis indications.

Keyword

Adolescent disc herniation; lumbar chemonucleolysis; microsurgical discectomy; posterior lumbar interbody fusion (PLIF)

MeSH Terms

Adolescent
Adult
Child
Diskectomy/instrumentation/*methods
Follow-Up Studies
Humans
*Intervertebral Disk Chemolysis
Intervertebral Disk Displacement/*surgery/*therapy
Lumbar Vertebrae/*surgery
Microsurgery
Spinal Fusion/instrumentation/*methods
Treatment Outcome

Figure

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  Fig. 1 A) Computed tomogram revealed left side soft disc protrusion. B), C) On discogram, the contrast dye leaked slightly. So we injected the chymopapain very slowly for 10 minutes. After chemonucleolysis, the pain subsided completely.

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  Fig. 2 A) A sequestrated disc particle migrated downward on the left side L3/4 segment. B) The extruded disc particle was shown on the left side L5/s1 segment. We performed microsurgical discectomy to remove the ruptured particle in 2 cases.

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  Fig. 3 A), B) Severe central canal stenosis due to posterior bony spur, and the so called apophyseal ring fracture is shown on computed tomogram. C), D) Postoperative X-ray showed PLIF with cages at the L4/5 segment and the complete removal of the bony spur.

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