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Lumbar Disc Herniation in the Adolescent Athlete

  • Andrew M. Cordover
  • Jacob B. Cordover
  • Glenn S. Fleisig
  • Jesse A. Raszewski
Chapter

Abstract

Participation in sports has been an important part of culture and childhood development. Injuries to the lumbar spine can preclude participation with devastating social, psychological, and physical consequences. The clinical presentation of adolescent lumbar disc herniations often differs from adult patients (less neurologic symptoms), frequently delaying the diagnosis. Lumbar disc herniations (LDHs) in adolescents have been treated surgically for almost 75 years. Of lumbar discectomy operations, adolescents account for between 0.5% and 4% of cases. Many factors contribute to lumbar disc herniations, including anthropometric, genetic, trauma, and variant anatomy. Ring apophyseal fractures (RAF) can be found in adults but are much more common in the skeletally immature patient. While clinical symptoms can be similar to a disc herniation, the treatment and prognosis for these can be different. Premature disc degeneration can also be found in the younger athlete. Nonsurgical treatment of a symptomatic adolescent disc herniation is often a reasonable option; however, many feel the outcomes are less favorable than for adult patients. When surgical treatment is pursued, returning to activities and sport is expected.

Keywords

Adolescent athlete disc herniation Pediatric lumbar disc herniation sports Adolescent athlete discectomy Adolescent athlete lumbar discectomy Athlete ring apophyseal fracture Adolescent athlete radiculopathy 

References

  1. 1.
    Hsu WK, McCarthy KJ, Savage JW, Roberts DW, Roc GC, Micev AJ, et al. The Professional Athlete Spine Initiative: outcomes after lumbar disc herniation in 342 elite professional athletes. Spine J. 2011;11:180–6.CrossRefGoogle Scholar
  2. 2.
    Watkins RG, Hanna R, Chang D. Return-to-play outcomes after microscopic lumbar diskectomy in professional athletes. Am J Sports Med. 2012;  https://doi.org/10.1177/0363546512458570.PubMedCrossRefGoogle Scholar
  3. 3.
    Wahren H. Herniated nucleus pulposus in a child of twelve years. Acta Orthop. 1945;  https://doi.org/10.3109/17453674508988913.PubMedCrossRefGoogle Scholar
  4. 4.
    Martínez-Lage JF, Fernández Cornejo V, López F, Poza M. Lumbar disc herniation in early childhood: case report and literature review. Childs Nerv Syst. 2003;  https://doi.org/10.1016/j.ptsp.2011.10.002.PubMedCrossRefGoogle Scholar
  5. 5.
    Slotkin JR, Mislow JMK, Day AL, Proctor MR. Pediatric disk disease. Neurosurg Clin N Am. 2007;18:659–67.PubMedCrossRefGoogle Scholar
  6. 6.
    Dang L, Liu Z. A review of current treatment for lumbar disc herniation in children and adolescents. Eur Spine J. 2010;19:205–14.PubMedCrossRefGoogle Scholar
  7. 7.
    Kumar R, Kumar V, Das NK, Behari S, Mahapatra AK. Adolescent lumbar disc disease: findings and outcome. Childs Nerv Syst. 2007;  https://doi.org/10.1007/s00381-007-0370-1.PubMedCrossRefGoogle Scholar
  8. 8.
    Ishihara H, Matsui H, Hirano N, Tsuji H. Lumbar intervertebral disc herniation in children less than 16 years of age: long-term follow-up study of surgically managed cases. Spine (Phila Pa 1976). 1997;  https://doi.org/10.1097/00007632-199709010-00022.PubMedCrossRefGoogle Scholar
  9. 9.
    Borgesen SE, Vang PS. Herniation of the lumbar intervertebral disk in children and adolescents. Acta Orthop Scand. 1974;45:540–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Ozgen S, Konya D, Toktas OZ, Dagcinar A, Ozek MM. Lumbar disc herniation in adolescence. Pediatr Neurosurg. 2007;  https://doi.org/10.1159/000098377.PubMedCrossRefGoogle Scholar
  11. 11.
    Epstein JA, Epstein NE, Marc J, Rosenthal AD, Lavine LS. Lumbar intervertebral disk herniation in teenage children: recognition and management of associated anomalies. Spine (Phila Pa 1976). 1984;  https://doi.org/10.1097/00007632-198405000-00019.PubMedCrossRefGoogle Scholar
  12. 12.
    Lagerbäck T, Elkan P, Möller H, Grauers A, Diarbakerli E, Gerdhem P. An observational study on the outcome after surgery for lumbar disc herniation in adolescents compared with adults based on the Swedish Spine Register. Spine J. 2015;  https://doi.org/10.1016/j.spinee.2015.02.024.PubMedCrossRefGoogle Scholar
  13. 13.
    Grobler LJ, Simmons EH, Barrington TW. Intervertebral disc herniation in the adolescent. Spine (Phila Pa 1976). 1979;  https://doi.org/10.1097/00007632-197905000-00014.PubMedCrossRefGoogle Scholar
  14. 14.
    David B, Alexander G. Herniation of the lumbar intervertebral disk in children and adolescents. Acta Orthop Scand. 1974;45:540–9.CrossRefGoogle Scholar
  15. 15.
    Çelik S, Göksu K, Çelik SE, Emir CB. Benign neurological recovery with low recurrence and low peridural fibrosis rate in pediatric disc herniations after lumbar microdiscectomy. Pediatr Neurosurg. 2012;47:417–22.CrossRefGoogle Scholar
  16. 16.
    Papagelopoulos PJ, Shaughnessy WJ, Ebersold MJ, Bianco AJ, Quast LM. Long-term outcome of lumbar discectomy in children and adolescents sixteen years of age or younger. J Bone Joint Surg Am. 1998;80(5):689–98.PubMedCrossRefGoogle Scholar
  17. 17.
    Sarma P, Thirupathi RT, Srinivas D, Somanna S. Adolescent prolapsed lumbar intervertebral disc: management strategies and outcome. J Pediatr Neurosci. 2016;11(1):20–4.PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Battié MC, Videman T, Kaprio J, Gibbons LE, Gill K, Manninen H, et al. The twin spine study: contributions to a changing view of disc degeneration†. Spine J. 2009;  https://doi.org/10.1016/j.spinee.2008.11.011.PubMedCrossRefGoogle Scholar
  19. 19.
    Videman T, Battié MC, Parent E, Gibbons LE, Vainio P, Kaprio J. Progression and determinants of quantitative magnetic resonance imaging measures of lumbar disc degeneration: a five-year follow-up of adult male monozygotic twins. Spine (Phila Pa 1976). 2008;  https://doi.org/10.1097/BRS.0b013e3181753bb1.PubMedCrossRefGoogle Scholar
  20. 20.
    Battie MC, Videman T, Gibbons LE, Fisher LD, Manninen H, Gill K. 1995 Volvo Award in clinical sciences. Determinants of lumbar disc degeneration. A study relating lifetime exposures and magnetic resonance imaging findings in identical twins. Spine (Phila Pa 1976). 1995;  https://doi.org/10.1177/0897190015615902.PubMedCrossRefGoogle Scholar
  21. 21.
    Zamani MH, MacEwen GD. Herniation of the lumbar disc in children and adolescents. J Pediatr Orthop. 1982;  https://doi.org/10.1097/01241398-198212000-00012.PubMedCrossRefGoogle Scholar
  22. 22.
    Cahill KS, Dunn I, Gunnarsson T, Proctor MR. Lumbar microdiscectomy in pediatric patients: a large single-institution series. J Neurosurg Spine. 2010;  https://doi.org/10.3171/2009.9.SPINE09756.PubMedGoogle Scholar
  23. 23.
    Epstein NE, Epstein JA. Limbus lumbar vertebral fractures in 27 adolescents and adults. Spine (Phila Pa 1976). 1991;  https://doi.org/10.1097/00007632-199108000-00017.PubMedCrossRefGoogle Scholar
  24. 24.
    Albeck MJ, Madsen FF, Wagner A, Gjerris F. Fracture of the lumbar vertebral ring apophysis imitating disc herniation. Acta Neurochir. 1991;  https://doi.org/10.1007/BF01402115.PubMedCrossRefGoogle Scholar
  25. 25.
    Bick EM, Copel JW. The ring apophysis of the human vertebra; contribution to human osteogeny. II. J Bone Joint Surg Am. 1951;  https://doi.org/10.2106/00004623-195133030-00025.CrossRefGoogle Scholar
  26. 26.
    Takata K, Inoue SI, Takahashi K, Ohtsuka Y. Fracture of the posterior margin of a lumbar vertebral body. J Bone Joint Surg Am. 1988;  https://doi.org/10.2106/00004623-198870040-00016.CrossRefGoogle Scholar
  27. 27.
    Wu X, Ma W, Du H, Gurung K. A review of current treatment of lumbar posterior ring apophysis fracture with lumbar disc herniation. Eur Spine J. 2013;22:475–88.PubMedCrossRefGoogle Scholar
  28. 28.
    Lavelle WF, Bianco A, Mason R, Betz RR, Albanese SA. Pediatric disk herniation. J Am Acad Orthop Surg. 2011;  https://doi.org/10.5435/00124635-201111000-00001.CrossRefGoogle Scholar
  29. 29.
    Singhal A, Mitra A, Cochrane D, Steinbok P. Ring apophysis fracture in pediatric lumbar disc herniation: a common entity. Pediatr Neurosurg. 2013;  https://doi.org/10.1159/000355127.PubMedCrossRefGoogle Scholar
  30. 30.
    Rajeswaran G, Turner M, Gissane C, Healy JC. MRI findings in the lumbar spines of asymptomatic elite junior tennis players. Skelet Radiol. 2014;43:925–32.CrossRefGoogle Scholar
  31. 31.
    Gerbino PG, d’Hemecourt PA. Does football cause an increase in degenerative disease of the lumbar spine? Curr Sports Med Rep. 2002;  https://doi.org/10.1249/00149619-200202000-00009.PubMedCrossRefGoogle Scholar
  32. 32.
    Bono CM. Low-back pain in athletes. J Bone Joint Surg Am. 2004;  https://doi.org/10.1177/036354657900700612.CrossRefGoogle Scholar
  33. 33.
    Bartolozzi C, Caramella D, Zampa V, Dal Pozzo G, Tinacci E, Balducci F. The incidence of disk changes in volleyball players. The magnetic resonance findings. Radiol Med. 1991;82(6):757–60.PubMedGoogle Scholar
  34. 34.
    Ong A. A pilot study of the prevalence of lumbar disc degeneration in elite athletes with lower back pain at the Sydney 2000 Olympic Games. Br J Sports Med. 2003;  https://doi.org/10.1136/bjsm.37.3.263.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Gomes Pinto FC, Poetscher AW, Quinhones FRE, Pena M, Taricco MA. Lumbar disc herniation associated with scoliosis in a 15-year-old girl: case report. Arq Neuropsiquiatr. 2002;60:295–8.CrossRefGoogle Scholar
  36. 36.
    Zhu Z, Zhao Q, Wang B, Yu Y, Qian B, Ding Y, Qiu Y. Scoliotic posture as the initial symptom in adolescents with lumbar disc herniation: its curve pattern and natural history after lumbar discectomy. BMC Musculoskelet Disord. 2011;12:216.PubMedPubMedCentralCrossRefGoogle Scholar
  37. 37.
    Weistroffer JK, Hsu WK. Return-to-play rates in national football league linemen after treatment for lumbar disk herniation. Am J Sports Med. 2011;  https://doi.org/10.1177/0363546510388901.PubMedCrossRefGoogle Scholar
  38. 38.
    Wang JC, Shapiro MS, Hatch JD, Knight J, Dorey FJ, Delamarter RB. The outcome of lumbar discectomy in elite athletes. Spine (Phila Pa 1976). 1999;  https://doi.org/10.1097/00007632-199903150-00014.PubMedCrossRefGoogle Scholar
  39. 39.
    Overley SC, McAnany SJ, Andelman S, Patterson DC, Cho SK, Qureshi SA, et al. Return to play in elite athletes after lumbar microdiscectomy. Spine (Phila Pa 1976). 2016;  https://doi.org/10.1097/BRS.0000000000001325.PubMedCrossRefGoogle Scholar
  40. 40.
    Fleisig GS, Hsu WK, Fortenbaugh D, Cordover A, Press JM. Trunk axial rotation in baseball pitching and batting. Sports Biomech. 2013;  https://doi.org/10.1080/14763141.2013.838693.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Andrew M. Cordover
    • 1
    • 2
    • 3
  • Jacob B. Cordover
    • 1
  • Glenn S. Fleisig
    • 1
  • Jesse A. Raszewski
    • 4
  1. 1.American Sports Medicine Institute (ASMI)BirminghamUSA
  2. 2.Department of Orthopaedic SurgerySt. Vincent’s HospitalBirminghamUSA
  3. 3.Andrews Sports Medicine and Orthopaedic CenterBirminghamUSA
  4. 4.Alabama College of Osteopathic MedicineDothanUSA

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