Surgical treatment of lower lumbar spine pathology in children and adolescents

Introduction. Analysis of the modern literature shows that the number of children complaining of low back pain of varying intensity in the spine increases annually. Publications on the surgical treatment of juvenile osteochondrosis were scarce. Currently, there are no algorithms for choosing a surgical treatment for children and adolescents with lumbar spine pathology, particularly high-grade listhesis, methods and terms of surgical treatment, and the use of reduction maneuvers remain debatable. There are no high-quality evidence studies. Aim. This study aimed to summarize the experience of treatment of children and adolescents with pathology of the lower lumbar spine. Material and methods. We performed a retrospective analysis of the treatment outcomes in patients with lower lumbar spine pathology who were younger than 18 years and who underwent surgery in the Neurosurgical Department No. 2 of the Tsiv’yan Novosibirsk Research Institute of Traumatology and Orthopedics between 2008 and 2018. The mean age of the patients was 15.5 years. We structured pathologies and interventions in children and adolescents and evaluated the clinical and radiological outcomes of treatment and the rate of intraoperative and postoperative complications. Results and discussion. From 2008 to 2018, 11,428 patients with degenerative spine disease and isthmic/dysplastic spondylolisthesis underwent surgery at the Neurosurgical Department No. 2. Of these, 55 (0.5%) patients were younger than 18 years. In all patients, surgical treatment led to pain relief and physical activity recovery. Decompression/stabilization surgery through the posterior approach enabled formation of an artificial block in 100% of cases. The rate of surgical treatment complications was 8.6% and 28.6% in children and adolescents with herniated lumbar intervertebral discs and spondylolisthesis, respectively. Conclusion. Surgical treatment of children and adolescents with pathology of the lower lumbar spine demonstrated an excellent clinical outcome. Disc herniation did not recur 4.9 years after decompression surgery for herniated lumbar intervertebral discs. Decompression/stabilization surgery through the posterior approach in children and adolescents with spondylolisthesis facilitated abolition of pain, regression of neurological disorders, full recovery of physical activity, and formation of a reliable artificial block. Potential complications were resolved without consequences and did not downplay the importance of surgical techniques in the treatment of this group of patients.