Lumbar disc herniation in a 14-month-old child: Report of a rare case at Viet Phap Hospital, Hanoi

Abstract

Purpose: To describe the clinical, lab tests, etiology and imaging characteristics of the lumbar disc herniation (LDH) case, then compare with similar rare cases described in the literature. Case-reported We report a rare case of LDH diagnosed in a 14-month-old child with spondylodiscitis (SpD). Magnetic resonance imaging (MRI) showed annular tear and left posterolateral disc herniation of L5-S. Confirmed having no trauma, this is one of the youngest cases reported in the literature with LDH caused by SpD. Conclusion Compared with similar rare cases in the literature, the above showed the similarities in clinical features and some radiological characteristics. The differences in lab tests of inflammation and MRI with contrast are consistent with an infectious cause due to SpD.
Case reported: A 14-month-old male child showed a normal history of psychomotor development. Gross motor development is of normal by having stood firmly and learned to walk since 11 months old, then walked independently since 13 months old. The disease progressed within 1 week, then it demonstrated that the child limping and crying more and more. No history of trauma found, but a history of acute nasopharyngitis one week earlier noted. General examination showed neither fever nor other abnormalities at the moment of admission. Active movements demonstrated limitation by crying when standing and refusing to walk. Passive movements in supine position showed normality of both hip joints. No abnormalities of neurological, digestive systems or bladder function noted. Lab tests were normal initially. MRI showed a posteriolateral annulus disc tear at L5-S1 disc level, nucleus pulposus compressed the left L5 root, triggered an inflammatory reaction of the left S1 nerve and adjacent soft tissue. The child followed up after several days revealed worse clinical symptoms and high fever. Lab tests showed elevated erythrocyte sedimentation rate and white blood cell count. Second MRI with contrast confirmed the images of discitis.
Conclusion: LDH is a very rare condition in young children. Rare cases reported in the literature almost always secondary to trauma. The case above is the youngest reported case of LDH due to SpD. Clinical and radiological features seemed similar when compared with similar rare cases in the literature.