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Lumbar Intervenebral Disk Herniation in Teenage Children: Recognition and Management of Associated Anomalies

EPSTEIN, JOSEPH A., MD*,§; EPSTEIN, NANCY E., MD*,§; MARC, JOSEPH, MD; ROSENTHAL, ALAN D., MD*,§; LAVINE, LEROY S., MD

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Herniated disks in children and adolescents can be extremely disabling and difficult to diagnose because of the paucity of neurologic abnormalities and the consequent suspicions of hysteria. The Laségue sign is often the only consistent positive finding, and when persisting without remission, justifies early diagnostic studies such as CT scanning, and electromyography. Myelography may be avoided if these studies are definitively diagnostic. The almost uniformly good results that follow diskectomy do not justify prolonged conservative care. Management is facilitated by awareness of often unrecognized structural abnormalities found in these patients. These include spinal stenosis, lateral recess narrowing, and transitional vertebra. Spinal fusion, while rarely indicated, should be considered where motion segment instability contributes to persistent backache. The management of 25 patients is recorded. Twenty-one of these presented with an anomaly worthy of record requiring modifications in surgical technique to provide proper decompression and lasting relief of symptoms

*From the Department of Neurological Surgery, Manhasset, New York

†From the Department of Radiology, Manhasset, New York

‡From the Department of Orthopaedics of the Long Island Jewish-Hillside Medical Center, New Hyde Park, New York

§From the Department of Neurosurgery of the North Shore University Hospital-Cornell Medical Center, Manhasset, New York

© Lippincott-Raven Publishers.