Treatment of lumbar disc herniation in the second decade of life.

Lumbar disc herniation is rare in patients under the age of 20 years. In the department of orthopaedic surgery of the University Hospital of Frankfurt, 33 patients below the age of 20 with lumbar disc herniation were treated over a period of 10 years. Eighteen were managed conservatively and 15 surgically. The purpose of this study is to report on the long-term outcome of these patients and to compare the results of conservative and surgical treatment. We analysed information obtained from the medical records, and for the long-term follow-up we prepared a questionnaire. The questionnaire was composed of general questions about the patients' lifestyle and their ability to return to a normal life and activity after treatment, together with a request for them to score their pain level and remaining symptoms. We found that the longest duration of symptoms before diagnosis was 72 months, with a mean duration of 11.1 months. Low back pain and monoradicular sciatica were the main complaints, but findings of neurological deficits were rare. Lasegue's sign and tight hamstrings seemed to be strong diagnostic signs in this age group. On the day of discharge, 94% of patients reported excellent or good results. The outcomes after a mean follow-up period of 5.4 years were similar in both treatment groups. Almost all patients were able to attain a normal activity level and few reported restrictions on their daily life. Only 14% complained of permanent pain and 7% reported poor results regarding their activity capabilities. In conclusion, we believe that in all cases of lumbar disc herniation in the second decade of life, conservative treatment should be pursued as a mainstay of treatment. Only after a certain time, if conservative treatment is ineffective, should surgical treatment be considered.