Juvenile lumbar disc herniation: impact of delayed diagnosis and surgical treatment on outcome in a 10-year single-center series

BACKGROUND: Lumbar disc herniation (LDH) is rare in juveniles and may present atypically, potentially delaying referral for neurosurgical evaluation. We aimed to assess diagnostic and treatment delays and to evaluate short-term surgical outcomes in pediatric patients undergoing microdiscectomy for LDH at our department over a 10-year period. METHODS: We retrospectively reviewed consecutive patients under 18 years of age who underwent microdiscectomy for LDH at our institution between 2015 and 2025. Clinical presentation, timing of imaging and surgery, and postoperative outcomes were analyzed. RESULTS: Twenty-one patients were included (mean age 14.6 ± 2.1 years, 57% females). Median body mass index (BMI) was 21.2 (range 18.7-36.9). All patients presented with low back pain, and 92.5% had radicular symptoms. The median time from symptom onset to MRI was 6 months (range 0-12 months), and to surgery 12 months (range 0-36 months). Most patients (90.5%) were operated at one level; L4/L5 and L5/S1 were the most commonly affected levels. At 3 months after surgery, 95.2% of patients reported improvement of back pain, while all patients experienced relief of radicular symptoms. CONCLUSION: In our cohort of pediatric patients with LDH, short-term outcomes following microdiscectomy were generally favorable despite substantial delays in diagnosis and referral for surgical treatment. These findings may suggest that, unlike in adults, prolonged symptom duration does not necessarily compromise recovery in children, although this should be interpreted with caution given the limited sample size and follow-up period. Nevertheless, increased awareness of pediatric LDH could facilitate earlier neurosurgical evaluation, streamline care pathways, and potentially further optimize patient management.