F Liquois1, P Demay, G Filipe. 1. Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand Troussenu, Paris.
Abstract
PURPOSE OF THE STUDY: Sciatica is very rare in children. We report a particular from due to traumatic avulsion of the posterior vertebral limbus. The purpose of this study was to give the principal clinical and radiological aspects of this entity and to discuss the treatment which should be different from that of common adult disk herniation. MATERIALS: From 1980 to 1992, 10 children were examined for a sciatica (7 boys and 3 girls aged from 10 years 1 month to 15 years 2 months). Sciatica appeared in all cases during sport activities and sometimes after a sport accident. Lumbar spine stiffness was encountered in all cases. Radiculalgia was unilateral in 7 cases, bilateral in 3 cases, in L5 territory in 3 and S1 in 7 cases. 4 children had deficitary neurological signs: 3 abolitions of achilles reflex, 1 weakness of foot dorsi-flexors. Standard x-rays showed in 4 cases the avulsed fragment in the vertebral canal. Spondylosis was encountered in 3 cases and spondylolisthesis in one case. Diagnosis was possible in all cases with CT Scan, M.R.I., when done showed a normal disk signal. Three children were managed by a conservative treatment by rest or brace. Seven had a surgical treatment: resection of the avulsed fragment in 6 and total diskectomy in one. The mean follow-up was five years (2 to 8 years). RESULTS: There was no complication. At last follow-up all children had a good result without sciatica recurrence. DISCUSSION: Many factors allow us to think that avulsion of the vertebral rim in children is of traumatic origin. CT Scan is the best exploration for this particular lesion. It enabled evaluation of fragment volume and location. Magnetic resonance imaging showed uninjured disks. Removal of the avulsed fragment without diskectomy seems possible in children.
PURPOSE OF THE STUDY: Sciatica is very rare in children. We report a particular from due to traumatic avulsion of the posterior vertebral limbus. The purpose of this study was to give the principal clinical and radiological aspects of this entity and to discuss the treatment which should be different from that of common adult disk herniation. MATERIALS: From 1980 to 1992, 10 children were examined for a sciatica (7 boys and 3 girls aged from 10 years 1 month to 15 years 2 months). Sciatica appeared in all cases during sport activities and sometimes after a sport accident. Lumbar spine stiffness was encountered in all cases. Radiculalgia was unilateral in 7 cases, bilateral in 3 cases, in L5 territory in 3 and S1 in 7 cases. 4 children had deficitary neurological signs: 3 abolitions of achilles reflex, 1 weakness of foot dorsi-flexors. Standard x-rays showed in 4 cases the avulsed fragment in the vertebral canal. Spondylosis was encountered in 3 cases and spondylolisthesis in one case. Diagnosis was possible in all cases with CT Scan, M.R.I., when done showed a normal disk signal. Three children were managed by a conservative treatment by rest or brace. Seven had a surgical treatment: resection of the avulsed fragment in 6 and total diskectomy in one. The mean follow-up was five years (2 to 8 years). RESULTS: There was no complication. At last follow-up all children had a good result without sciatica recurrence. DISCUSSION: Many factors allow us to think that avulsion of the vertebral rim in children is of traumatic origin. CT Scan is the best exploration for this particular lesion. It enabled evaluation of fragment volume and location. Magnetic resonance imaging showed uninjured disks. Removal of the avulsed fragment without diskectomy seems possible in children.