Herniated discs in children can occur due to many possible causes and are statistically far more common than one might expect to find in such a youthful demographic. Intervertebral herniations are certainly more prevalent in adults, but are still found in a great number of juveniles, both with and without back or neck pain symptoms.
Herniations in young people are often quite different that those found in older patient populations. This is because the spinal discs have usually not suffered any degree of desiccation at such an early age, so bulges and ruptures will behave quite differently in many instances.
This commentary examines the occurrence of all varieties of herniated discs in children and teenagers. We will detail the diagnostic process, the most common causes and the potential symptoms of juvenile spinal disc abnormalities. We will also provide some helpful recommendations to improve the prognosis for youth-related disc irregularities.
Diagnosis of intervertebral abnormalities in children is often not related to the existence of back or neck pain. In fact, approximately half of all juvenile herniations are discovered when testing for some unrelated health matter. This fact should not surprise any reader, since most herniations are not symptomatic, regardless of where they occur in the vertebral column or the age of the person who experiences the irregularity.
When herniations are discovered inadvertently, they should not be manufactured into causes for concern, as long as they do not factor into any current health problem or pain complaint. Therefore, diagnosticians must be very careful how the discovery is presented, both to young patients and their parents.
Raising the specter of possible future pain will only create anxiety and might even set the right circumstances for back or neck symptoms to actually commence, due to pure nocebo suggestion and not from any anatomical mechanism.
When a herniated disc is located through evaluation of a back or neck pain complaint, then the intervertebral spacer must be thoroughly studied to implicate or acquit it of causing the symptomatic expression. In no case should a herniation be assumed as the primary or sole source of pain without demonstrating the existence of a pathological component to the protrusion.
Juvenile bulging discs can cause pain through the same processes which generate symptoms in any other variety of pathological herniation. These mechanisms include central spinal stenosis, neuroforaminal stenosis leading to a compressive neuropathy or chemical irritation of neighboring nerve tissues in the case of a ruptured and leaking disc structure.
In cases of herniations which lack symptomatic expression, there may or may not be a verified means of determining the cause. This is especially true in patients who do not have the benefit of previous imaging studies that show a prior absence of the present disc abnormality. Remember, the majority of herniations do not cause pain or neurological symptoms, since they do not influence surrounding nerve tissues to any significant degree.
Meanwhile, painful herniations might be slightly easier to trace to a definitive cause, although this is not always the simple truth of the matter. Even when pain begins after a known trauma, there is no sure way to tell if the herniation existed prior to the recent injury or not, without the benefit of a prior imaging study. In essence, the injury may have caused the herniation, the injury may have worsened the herniation or the herniation may have already existed and pain may be due to another consequence of the injury.
Since youthful discs are fully hydrated, they are not prone to the types of degeneration-enacted bulging we see in older patients. Therefore, the most common logical explanation for juvenile herniated discs is certainly traumatic injury.
Discs can bulge or rupture from any sizeable stress factor, including sports injuries, vehicular collisions, falls and acts of violence. Some young patients might have congenital disc abnormalities or early-developmental irregularities that might be linked to a genetic predisposition.
Problematic herniations might cause a number of possible expressions, depending on the mechanism that is generating the symptoms. The most common expressions include pain, as well as the existence of neurological symptoms, such as paresthesia and weakness in various regions of the anatomy.
For more information, please read our herniated disc symptoms resource section for a thorough accounting of all possible expressions.
When juvenile and teen herniated discs are symptomatic, they may be less prone to resolving without interventional treatment. Herniations might also be less successfully treated using conservative forms of therapy in younger patients.
The reason why this occurs is due to the healthy and moisture-rich nature of young spinal discs. Since these youthful intervertebral spacers have not desiccated in any way, they are fully capable of sustaining bulging pressure against neurological tissues, which rarely occurs from degenerated disc types.
Surgical interventions are more slightly more effective statistically for providing relief from acute juvenile disc symptomologies. However, spinal surgery is a terrible ordeal for a young person to face. Furthermore, damage to the disc will be significant in virtually every case of operative treatment, including the most popular forms of discectomy.
Many juvenile patients might be best off considering the least invasive approaches to surgical care, if and when a procedure is truly needed. Techniques such as nucleoplasty and IDET might be ideal to minimize collateral damage to the spine, while still resolving the symptomatic mechanism in the swollen disc.
Regardless of the nature of the disc condition, or the therapy path decided upon, it is absolutely vital to keep the psychoemotional state of the youthful patient in mind throughout the evaluation and treatment processes. Failure to do so might lead to the perception of permanent injury. This is a noted criterion in the development of chronic pain that is caused by, or contributed to, through the involvement of the subconscious mind. Meanwhile, reassured patients, who are confident in their recovery, demonstrate a far lower risk of being stricken with enduring symptoms.