Nonoperative management of multilevel lumbar disk herniations in an adolescent athlete

Mayo Clin Proc. 1992 Feb;67(2):137-41. doi: 10.1016/s0025-6196(12)61314-7.

Abstract

Herniated lumbar nucleus pulposus is rare in the pediatric age-group; for surgically proven cases, the estimated prevalence is between 0.8 and 3.2%. Most of the current literature indicates that herniated nucleus pulposus in pediatric patients differs from that in adult patients in epidemiologic characteristics, clinical manifestations, and frequency of associated neurologic findings. To our knowledge, the current case is the first published report of lumbar disk herniations at three levels in a 15-year-old male adolescent, whose abnormalities were verified by computed tomography and myelography. Most investigators recommend surgical treatment; however, our patient had good results with nonoperative management that consisted of nonsteroid anti-inflammatory drugs, passive extension, lumbar traction, segmental mobilization, and a progressive program of dynamic lumbar stabilization exercises. The patient is now asymptomatic and able to participate in selected limited contact sports and most farm activities; however, contact sports are prohibited for 1 year. If follow-up computed tomographic imaging of the lumbar spine demonstrates no progression of the disk abnormalities and if the patient remains asymptomatic, he could consider participation in contact sports after necessary conditioning.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Athletic Injuries / diagnostic imaging
  • Athletic Injuries / etiology
  • Athletic Injuries / therapy*
  • Bed Rest
  • Braces / standards*
  • Clinical Protocols / standards*
  • Exercise Therapy / standards*
  • Humans
  • Intervertebral Disc Displacement / diagnostic imaging
  • Intervertebral Disc Displacement / etiology
  • Intervertebral Disc Displacement / therapy*
  • Male
  • Naproxen / administration & dosage
  • Naproxen / therapeutic use*
  • Patient Education as Topic
  • Physical Therapy Modalities / standards
  • Tomography, X-Ray Computed
  • Traction

Substances

  • Naproxen