J Manipulative Physiol Ther. 1997 Oct; 20(8): 551-6.

Protruded lumbar intervertebral nucleus pulposus in a 12-year-old girl who recovered after nonsurgical treatment: a follow-up case report.

Zhao P, Feng TY.

People's Liberation Army Research Center of Traditional Chinese Manipulative Orthopedics, People's Liberation Army Air Force General Hospital, Beijing, People's Republic of China.

OBJECTIVE: To discuss the nonsurgical treatment of a lumbar intervertebral disc protrusion with obvious neurological irritation in a juvenile patient. CLINICAL FEATURES: A 12-yr-old girl suffered from low back and right leg pain that came on after a lengthy walk. There was a limp on the right, with pain also radiating to the right leg. A diagnosis of lumbar disc herniation was made after advanced imaging methods were applied. INTERVENTION AND OUTCOME: The girl underwent special spinal rotational manipulation, epidural injection and, later on, physical exercises. She did not respond to the manipulation as adult patients with similar signs do; in her case, response did not occur until nearly 1 month of hospitalization. A follow-up study with computed tomography, plain and dynamic radiology and thermography found that the protruded nucleus pulposus was not changed in size and position and the functional recovery of her lumbar spine was far from fulfilled until 8 months after being dismissed from the hospital. CONCLUSION: Juvenile patients suffering from lumbar disc protrusion are rare and seldom undergo conservative treatments, especially when obvious neurological irritation occurs. This case shows the difficulties in managing the juvenile patient with conservative care. Doctors or specialists should always be cautious about manipulating juvenile patients with too much force.