Juan David Serrano Alonso (Madrid / ES), Belén Pastor Romero (Cuenca / ES), Alejandra Gómez Rodríguez (Madrid / ES), Eva García Jarabo (Madrid / ES), Alba Gómez Sánchez (Madrid / ES), Rafael Marti Ciruelos (Madrid / ES)
Abstract text (incl. references and figure legends)
Case history
Two-year-old male patient with pain and limp in his right lower limb after trauma.
Clinical findings
On examination, he had pain in the lumbar spinous processes.
Investigation/Results
Laboratory test showed no abnormalities. Radiography and ultrasound of the hips were normal, so he was admitted for study. A scintigraphy was performed, showing pathological accumulation in L5-S1. Suspecting discitis, MRI was indicated. It showed decreased height loss in the L5-S1 disc space and a mass with a density similar to the nucleus pulposus. The mass was occupying the anterior epidural space within the body of L5 and the right lateral recess L5-S1, contacting the right L5 and S1 roots, finding consistent with a traumatic L5-S1 disc herniation.
Diagnosis
Post-traumatic disc herniation in a two-year-old boy.
Therapy and Progressions
Conservative treatment was chosen using intravenous analgesia and corticotherapy, achieving clinical remission. Two years later, an MRI shows loss of signal in the L5-S1 disc associated with disc desiccation without canal invasion or root involvement. The patient is now asymptomatic and leads a normal life.
Comments
Disc herniation is very rare in children and usually caused by trauma, disc degeneration or congenital malformation. Diagnosis is complicated due to the immaturity of the skeleton. The clinic may include low back pain, radiculopathy and even motor or sensory deficit. Even if the hernia is confirmed, surgery is not usually necessary since pediatric patients respond better than adults to conservative treatment. Surgical intervention is reserved in case of need for spinal cord decompression (radicular pain associated with motor deficit).
References
Haidar, R., Ghanem, I., Saad, S., Uthman, I. (2010). Lumbar disc herniationi in young children. Acta paediatrica (Oslo, Norway: 1992), 99 (1), 19-23.
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