Adolescent Cauda Equina Secondary to Traumatic Lumbar Disc Herniation: A Rare Case Report with Review of Literature.

INTRODUCTION: Lumbar disc herniation is a common spinal pathology, but its occurrence in the pediatric population is a rare entity. These patients are relatively asymptomatic, and the presence of a neurological deficit is rare. We present a case of an acute lumbar disc herniation presenting with cauda equina syndrome (CES) in a 13-year-old child, along with a review of the literature on the topic.

CASE REPORT: A 13-year-old male child presented to us in the emergency department with complaints of low back pain, weakness, and urinary incontinence following lifting of a heavy weight 25 days back. On examination, he had motor and sensory deficits at the L5 and S1 regions along with perianal anesthesia. Magnetic resonance imaging showed a central disc protrusion at the L4-L5 level. The patient underwent central decompression. He showed both functional and neurological recovery in follow-up.

CONCLUSION: Lumbar disc herniation is a rare cause of back pain in children. Several factors were identified as potential causes of pediatric lumbar disc herniation, among which trauma is the most common. Neurological deficits are rare in children, largely because a more mobile spine prevents nerve root compression. Surgery is indicated in pain not responding to 4-6 weeks of conservative treatment, CES, progressive neurological deficits, and correlating spinal deformities. There are very few cases of CES due to lumbar disc herniation in adolescent children reported in the literature. We reviewed the available literature and identified 6 such cases, tabulating the findings.