Size Matters: Which Adolescent Patients Are Most Likely to Require Surgical Decompression for Lumbar Disk Herniations?
| Autor: | Chan Hee Jo, Mohammed A. Khaleel, Marcel R. Wiley, Amy L. McIntosh |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Decompression medicine.medical_treatment Conservative Treatment 03 medical and health sciences Spinal Stenosis 0302 clinical medicine Lumbar Discectomy medicine Humans Orthopedics and Sports Medicine Child Retrospective Studies Observer Variation 030222 orthopedics Lumbar Vertebrae medicine.diagnostic_test business.industry Reproducibility of Results Magnetic resonance imaging Retrospective cohort study General Medicine Decompression Surgical Prognosis medicine.disease Magnetic Resonance Imaging Sagittal plane Spondylolisthesis Surgery medicine.anatomical_structure Pediatrics Perinatology and Child Health Cohort Female business Intervertebral Disc Displacement |
| Zdroj: | Journal of Pediatric Orthopaedics. 39:e791-e795 |
| ISSN: | 0271-6798 |
| Popis: | BACKGROUND Lumbar herniated nucleus pulposis (HNP) occurs infrequently in the pediatric/adolescent population. A minority of patients with radicular symptoms fail to improve with conservative management and require discectomy. The authors hypothesize that children who ultimately require surgical intervention have an underlying lumbar stenosis predisposing them to continued symptoms. METHODS Pediatric patients with a lumbar HNP on advanced imaging were retrospectively identified at a tertiary pediatric orthopaedic institution. Patients with spondylolisthesis, fractures, previous spine surgery, or structural thoracolumbar scoliosis were excluded. On sagittal magnetic resonance imagings, measurements were taken of the L4 and L5 vertebral body diameters (VBD) and canal diameters (CD) by 2 independent reviewers. Statistical analysis was performed using 2 sample T tests followed by logistic regression analysis. This was utilized to identify significant associations between CD and need for surgical decompression. RESULTS A total of 76 patients (37 males/39 females) were identified with a lumbar HNP from 2001 to 2016. Eleven patients underwent discectomy. Sixty-five patients were managed conservatively. Age at magnetic resonance imaging was not different between groups (15.1±1.7 vs. 14.9±2.2 y, P=0.82). VBD at L4 and L5 were not different between groups (P=0.2 and 0.36, respectively). The reviewers had fair to good (0.584-0.854) interrater reliability correlation coefficients. CD was decreased in the surgically treated cohort at L4 (11.6±1.6 vs. 14.2±2.1 mm, P=0.0002) and at L5 (10.1±1.3 vs. 14.2±2.2 mm, P |
| Databáze: | OpenAIRE |
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