Discectomy for Lumbar Disc Herniation in Pediatric and Adolescent Populations: A Systematic Review and Meta-Analysis.

ABSTRACT

Corroborative evidence for discectomy in pediatric or adolescent patients remains scarce, with this single-arm meta-analysis investigating discectomy for lumbar disc herniation (LDH) within this population. PubMed, Embase (Elsevier), CiNAHL, Cochrane Library, Scopus, and Web of Science were searched. Eligible studies reported pediatric patients under 21 years of age with a diagnosis of LDH that was treated surgically with discectomy. This review was registered in PROSPERO (ID CRD42023463358). Twenty-two studies met the eligibility criteria (n=1182). Visual analog scale (VAS) scores for back pain at baseline were 5.34 (95% CI 4.48, 6.20, I2=98.9%). Postoperative VAS back pain scores after 12 months were 0.88 (95% CI 0.57, 1.19, I2=95.6%). VAS scores for leg pain at baseline were 7.03 (95% CI 6.63, 7.43, I2=93.5%). Postoperative VAS leg pain scores after 12 months were 1.02 (95% CI 0.68, 1.36, I2=97.0%). Oswestry disability index (ODI) scores at baseline were 55.46 (95% CI 43.69, 67.24, I2=99.9%). Postoperative ODI scores after 12 months were 7.82 (95% CI 4.95, 10.69, I2=99.4%). VAS back, VAS leg and ODI scores demonstrated a minimum clinically important difference (MCID) at all postoperative points. Perioperative outcomes demonstrated operative time as 85.71 mins (95% CI 73.96, 97.46, I2=99.4%) and hospital length of stay as 3.81 days (95% CI 3.20, 4.41, I2=98.5%). The postoperative reoperation rate at the same level was 0.01 (95% CI <0.00, 0.02, I2=0%). Discectomy appears safe and effective in pediatric and adolescent patients suffering from LDH. The findings here provide groundwork for future randomized control trials against conservative measures to elaborate on optimal management and elucidate long-term outcomes.