Next will be Malia McEvoy discussing lumbar disc herniations in the pediatric population. Thank you. So there are no disclosures related to this presentation. The number of pediatric patients undergoing lumbar myocardial discectomy are pretty small compared to adults. And as such, there's not much literature to guide treatment as much as there is in the adult literature. So, but it's unclear whether or not the findings in the adult literature can be applied to the treatment of pediatric disc herniations. So in order to better understand these outcomes of pediatric lumbar myocardial discectomy, we performed a retrospective review of all of the patients at Boston Children's Hospital who underwent lumbar myocardial discectomy within 19 years. And these procedures were performed by the two senior authors, Dr. Stone and Dr. Proctor. So within this series of 199 patients, the average age was 16 years and 56% of these patients were female. The most common presenting symptom by far was radicular pain, 88% of patients had unilateral radicular pain while bilateral was present in 10% of patients. Many of these patients also had back pain, 60% in the total series. And bowel and bladder changes were less common, only present in 4.5% of patients. Eighty-five percent of patients underwent unilateral discectomy and 88% of patients had been operated at one level. The levels L4 and L5 and L5-S1 were most commonly operated. And as you can see from the picture on the right, the pediatric disc is often removed in very small pieces versus an adult disc which is often extruded in a large fragment. So the pediatric disc often requires much more time to remove. So pediatric patients tend to do very well after their procedure. They tend to return to their daily activities very well. And by the first month of follow-up, there were 89% of patients had returned to their school. And the mean time to return to sports was 9.8 weeks after surgery. And upon the first follow-up appointment, 93% of patients reported minimal or no pain. And among patients who had some residual deficits, these deficits were much less severe than the preoperative symptoms. And the time from the date of procedures in the study and the time of the retrospect analysis was on average nine or seven years. So the total number of complications in this series was 10 patients. There were six cases of cerebrospinal fluid leaks, including two which were intraoperative. And those two intraoperative cases were repaired during the initial procedure. Whereas there were four cases of postoperative CSF leaks. These were repaired using an additional intervention. And there were three cases of wound infection, including one case of dysgitis. And all of these cases were repaired with repeat intervention. And there's one case of a new neurological deficit, but this patient ended up doing very well and improved over time. In terms of the patients who underwent reoperation, there were 10 patients total. There were 11 procedures. So there were three patients who underwent repeat discectomy at the same level. And eight patients who underwent discectomy at a different level. And there's one patient who underwent a subsequent fusion. So in terms of the patients who are at risk for pediatric lumbar discectomy, there are three main groups. Patients who play sports, so 70% of patients in the series were athletes. And of the non-athletes, 65% of patients had BMI greater than 25, so obesity is also a significant risk factor. And interestingly, 56% of patients in the series were females. So we're actually doing another study to further understand this gender predisposition. So among the athletes in this series, here's a breakdown of all the different sports that were played. So if you look at the top three sports that were played by female athletes, those were basketball, dance, and soccer. And among male athletes, the most common sports were football, basketball, and weightlifting. So the average time from onset of symptoms of lumbar discectomy was 11 and a half months. And all patients undergo trial conservative therapy. According to a previous study that's done in our institution, 42% of pediatric disc herniation patients progressed to surgery. So in conclusion, this procedure, lumbar microcectomy is a safe procedure for pediatric patients with symptomatic disc disease that have tried and failed a trial conservative therapy. And risk factors for this procedure include female sex, participation in sports, and high BMI. And relief of pain and return to daily activities is readily achieved in these patients. Thank you.

lumbar disc herniations

pediatric population

retrospective review

lumbar microdiscectomy

Boston Children's Hospital