Farzad Omidi-Kashani1, Ebrahim Ghayem Hasankhani1, Ehsan Rafeemanesh2. 1. Orthopedic Department, Orthopedic Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. 2. Occupational Medicine Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
This letter is written in response to a note recently published regarding to the case report entitled "sciatica in a five year old boy" by Omidi-Kashani et al. [1] which had been published in June 2014 issue in the "Asian Spine Journal" [1]. We agree with the authors in that pediatric sciatica is commonly caused by lumbar disc herniation, although apophyseal ring fracture may even be more prevalent in this age group, despite the fact that both have very low incidences and are infrequently encountered in the literature [2,3]. Another important point worth mentioning regarding pediatric sciatica, is the lower incidences of secondary neurologic deficits due to increased resilience of the neural tissue in pediatric patients. This resilience often makes physical findings usually seen in adult patients such as muscular weakness, paresthesias, or impaired reflexes less pronounced thus limiting the exam where a positive straight leg raising may be the only positive finding [4]. Lastly, it is important that spondylolysis and spondylolisthesis are also kept in mind before considering the more unusual causes, especially in this young population [5].