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Ginger Bryant, MD, Prasit Nimityongskul,
MD, Frank Greiner, MD, University of South Alabama, Mobile,
AL
Low back pain, with or without
radioculopathy, is a prevalent complaint among the adult patient
population. While herniated nucleus propulsus is a common
etiology of symptoms in this patient group, typically presenting
in the third to fifth decades of life, it is rarely found
to be the cause of back pain in the pediatric patient. When
children and adolescents present with back pain, medical professionals
must consider a unique set of differential diagnoses including
diskitis, trauma, congenital deformities, scoliosis, and neoplasms.
Even though these entities are the more common causes of back
pain in the younger patient, physicians must remember that
herniated disk is within the differential, and will present
with signs and symptoms similar to those seen in the adult
population.
This case involves a nine-year
old girl who presented with a three-month history of low back
pain, unilateral leg pain, and intermittent lower extremity
paresthesias. She denied any history of trauma. Physical examination
revealed strongly positive tension signs and other findings
consistent with S-1 radiculopathy. Nerve root impingement
due to herniated nucleus propulsus was confirmed by magnetic
resonance imaging. After failing conservative treatment, she
underwent lumbar laminectomy and diskectomy. At one-month
follow-up, the patient reported resolution of all symptoms.
Based on current literature, we believe this patient is one
of the youngest patients with classic disk herniation causing
nerve root impingement.
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