Minimally invasive tubular lumbar microdiscectomy in pediatric patients: a single-center case series

PURPOSE: Minimally invasive tubular lumbar microdiscectomy (MIS-MCD) is used for lumbar disc herniation (LDH) in adults, but pediatric data remain limited. This study aimed to evaluate clinical presentation, perioperative outcomes, and recovery patterns after MIS-MCD, and to explore risk factors for reherniation and reoperation in a pediatric cohort. METHODS: We performed a retrospective case series of consecutive pediatric patients undergoing primary single-level MIS-MCD for LDH from 2014-2024 at a tertiary center by a single surgeon. Patients with primarily traumatic, neoplastic, or infectious pathology were excluded. Primary outcomes included early symptom improvement, return to activities, reherniation, and reoperation. Risk factors for reherniation were explored using Fisher's exact tests. RESULTS: Thirty-four patients were included (mean age 16.7 ± 1.7 years; 55.9% male; mean BMI 30.6 ± 7.4 kg/m2). Most participated in organized sports (58.9%), with sport/exertional mechanisms being the most common identifiable cause (41.2%). Congenital spinal stenosis (CSS) was present in 20.6%. Mean symptom-to-surgery interval was 9.2 ± 8.3 months. Length of stay was 0.5 ± 0.6 days, median blood loss was 15 mL, and no durotomies occurred. Initial symptom improvement was reported by 94.1%, and 79.4% returned to prior activities. Over a median follow-up of 20.4 months, reherniation occurred in 8 patients (23.5%) and reoperation in 6 (17.6%). Reherniation was significantly associated with CSS (62.5% vs. 7.7%; p < 0.001). All reoperations were repeat MIS-MCD; none required fusion. CONCLUSION: MIS-MCD is safe and effective in pediatric patients. Reherniation is concentrated in patients with CSS, suggesting preoperative canal narrowing identification may guide counseling and surveillance.