Our youngest child was just diagnosed with an L45 disc protrusion. We have never had anything like this in our family. What can you tell us about the causes and most likely treatment? We go back tomorrow for the plan of care, which I’m pretty sure is going to involve antiinflammatory drugs and physical therapy.

Leg pain and numbness down the leg (without back pain) is actually the most common symptom reported by children who have disc herniations. Stiffness and loss of motion are common. A history of trauma or injury associated with sports is an important clue.

Most of the time, conservative (nonsurgical) care is the primary focus of treatment. This approach begins with antiinflammatory medications and physical therapy. If the painful back and/or leg symptoms don’t resolve, then a steroid injection may be considered. In a small number of cases, surgery is required.

Risk factors include heavy lifting, previous back injuries, and repetitive motions. Falls associated with athletic and sports activities are additional risk factors. For other patients, sudden increases in training, poor conditioning, or decreased spine range-of-motion increase the risk of disc herniation. It’s possible that congenital defects (present at birth) contribute to disc herniations but this hasn’t been proven directly.

Motions that put stress on the disc and increase pressure within the disc itself are more likely to lead to injury of the disc. For example, repeated flexion (bending) of the lumbar spine (low back), compression down through the spine, and spinal rotation or twisting can tear the outer covering of the disc. This area is called the annulus fibrosis.

Rest from all repetitive, sports, and recreational activities is advised. Patients should not strain, bend, extend, or sit for long periods of time. These positions and activities increase pressure on the discs.

A physical therapist will help guide patients through exercises designed to gently nudge the protruding disc back into its normal anatomic space. Core training to stabilize the spine is another important program the therapist will provide and supervise.

For patients who do not have neurologic symptoms (e.g., numbness, tingling, loss of bowel or bladder control, muscle weakness, foot drop), conservative care is usually very successful. Anytime a conservative approach fails to produce the desired results, more aggressive treatment may be needed.

Surgery to remove the bulging disc or disc fragments may be advised. This procedure called a discectomy must be done carefully in the pediatric population. The growing spine must be protected to preserve spinal stability. For this reason, open incision discectomy is the standard technique used to give the surgeon better visual access and control of the surgical area.