Adolescent disc herniation was first described by Wahren in 1945. The intervertebral discs of adolescents are in the developmental stage and have not yet degenerated and are generally less prone to do so. In an epidemiological study conducted by Zitting et al, 12,058 Finnish children and adolescents from birth to 28 years of age were followed up and the results showed that no children were admitted to hospital with a diagnosis of lumbar disc herniation before the age of 15 years, and the prevalence increased to 0.1% to 0.2% at the age of 2O. The prevalence began to increase significantly after the age of 20, and by the age of 28, 9.5% of males and 4.2% of females were hospitalized with a diagnosis of lumbar disc herniation, respectively. However, in recent years, the incidence has increased year by year due to lifestyle, computer popularity, traffic accidents, and reduced exercise. The etiology of adolescent disc herniation is, according to most scholars, probably related to lumbar trauma, structural abnormalities of the lumbar spine, premature degeneration of the intervertebral disc, and genetics. Reviewing the literature, common causes include trauma, degeneration, congenital malformations, genetics, and developmental abnormalities, etc. Lee et al. concluded that trauma is the main cause of lumbar disc herniation in adolescents. Fakouri et al. reported that genetic factors play a dominant role in the pathogenesis of lumbar disc herniation in adolescents, with 13% to 57% of adolescents with lumbar disc herniation having a similar disease in their immediate family. Rapid growth, height and weight overload in adolescents increase the burden on the lower back and predispose them to the disease. High body mass index and low physical activity also increase the incidence of lumbar disc herniation in adolescents. s1ivers et al. suggest that adolescents with disc herniation are associated with weakness and rupture of the annulus fibrosus in three major ways: (1) inadequate nutrition of the disc and part of the annulus fibrosus; (2) wear and tear of the annulus fibrosus due to intervertebral motion and subsequent fibrous degeneration; and (3) various traumatic injuries. In addition, spinal abnormalities such as scoliosis, migrating vertebrae, and epiphyseal separation are greatly related to the occurrence of lumbar disc herniation in adolescents. Clinical features and imaging characteristics The clinical manifestations of adolescent disc herniation differ greatly from those of adult lumbar disc herniation. Its characteristics: ① Light symptoms and heavy signs. The clinical manifestations are light lumbar pain and sciatica, while lower limb sensation, movement, muscle atrophy and tendon reflex changes are more common, and straight leg raise test is often positive; ② congenital developmental abnormalities of the lumbar region, such as sacral lumbarization, lumbar sacralization, transverse hypertrophy and other congenital deformities; ③ there is often a clear history of trauma and strenuous activity; ④ lumbar deformity is heavy, common lumbar stiffness, compensatory scoliosis or kyphosis; ⑤ predominantly male predominantly male. Imaging characteristics: ① most of the lumbar spine X-ray plain films have no special findings, a few can show the affected intervertebral space is unequal in width anteriorly and posteriorly, or accompanied by abnormalities such as lumbar sacralization and sacral lumbarization; ② CT, MRI and other imaging examinations can well clarify the gap and degree of protrusion and its compression of the dural sac and spinal nerve; ③ L4-5 and L5S1 are the preferred sites of disc protrusion. Treatment The current treatment for lumbar disc herniation in adolescents is mainly conservative, but for patients with clear indications for surgery, surgery should be performed as early as possible, and the surgical option has been recognized as minimally invasive surgery as the first choice. Non-surgical treatment There are many non-surgical treatment methods, including drugs, massage, lumbar traction, local braking and lumbar back exercises. Most early and mild lumbar disc herniation in adolescents can be treated satisfactorily. Surgical treatment: traditional open laminar decompression discectomy, intervertebral discoscopy, foraminoscopy, internal fixation fusion surgery, etc. Patients with lumbar disc herniation in adolescents should undergo surgery as early as possible when conservative treatment is ineffective or when the surgical guidelines are clear, but the indications for surgery should be strictly controlled: ① adolescents with lumbar disc herniation for which short-term strict non-surgical treatment is ineffective; ② those with developmental spinal stenosis; ③ obvious signs of nerve injury such as muscle atrophy, decreased muscle strength, and decreased nerve reflexes; ④ symptoms of cauda equina compression; ⑤ (5) those with large protrusions, significant nerve root compression in the dural sac, and prolapsed or free nucleus pulposus on CT or MRI; (6) those with multiple recurrent episodes. The short-term efficacy of traditional open discectomy for lumbar disc herniation in adolescents is positive, and this procedure can safely and completely resolve the protruding compression material. However, the surgery is highly traumatic and damages muscles, ligaments and bony structures. In the long term, it still has a significant impact on scar formation and spinal stability. With the development and maturity of minimally invasive technology, this procedure has been gradually eliminated. The application of lumbar fusion in adolescent patients with lumbar disc herniation has also been reported in the literature. The purpose of fusion is to eliminate the state of instability due to damage to the bone and synovial and disc structures of the three-joint complex of the lumbar spine after disc surgery, to eliminate the painful stimulation of the synovial membrane of the synovial joint capsule, the posterior longitudinal ligament of the intervertebral disc and the sinus vertebral nerve endings in front of the dura, and to reduce symptoms by restoring the stability of the lumbar spine. However, many scholars believe that spinal fusion cannot be routinely performed in adolescents with lumbar disc herniation. Indications for spinal fusion in adolescents with lumbar disc herniation include: (1) patients with lumbar disc herniation with lumbar slippage or significant lumbar instability; (2) patients with more laminectomies; and (3) patients with congenital degeneration or medically induced instability of the intervertebral subtalar joints. Many studies have confirmed that because lumbar fusion comes at the cost of increased operative time and more blood loss, it does not improve outcomes and reduces the recurrence rate of severe disc herniation. Percutaneous laser disc decompression (PLDD) is less invasive, has a faster recovery, and is easily accessible to adolescents. The procedure maintains the integrity of the spinal canal and the relative stability of the vertebral body, which is of special significance to the patient’s own vertebral stability in the long term. However, the indications for the procedure are extremely strict and are only indicated for patients with mild disc herniation or bulging. Minimally invasive discoscopy (percutaneous full-endoscopic discectomy (MED)) is less invasive, maintains spinal stability, and has fewer complications. MED currently provides a good approach for the treatment of lumbar disc herniation in adolescents. The efficacy of MED for adolescent lumbar intervertebral disc herniation has been confirmed, and the domestic and international literature reports an excellent surgical rate of 94% to 100%. However, MED is still an open surgery, which still requires certain exposure, postoperative adhesions can occur, and the recovery time is close to that of open surgery. Percutaneous full-endoscopic discectomy (percutaneous full-endoscopic discectomy) for adolescent disc herniation is a new type of minimally invasive surgery that has emerged only in recent years. The fully endoscopic transvertebral foramen or interlaminar maneuver is a truly new technique in minimally invasive spine surgery. The system operates with a 4.2 mm diameter channel and a 7.9 mm outer diameter, and is equipped with a microscopically flexable radiofrequency, planer and grinding drill. Under direct 25° endoscopic vision and continuous perfusion of low-pressure fluid, the removal of the nucleus pulposus of the cervical, thoracic and lumbar discs can be accomplished through a tiny window of several mm in the interlaminar ligament or intervertebral foramen. The advantages of this method are: (1) posterior lateral transvertebral foramen or translaminar approach does not destroy the bony structure of the spinal canal; (2) the patient is operated under local anesthesia while awake, avoiding nerve injury; (3) the treatment targets the herniated tissue without removing the bony structure and ligaments, ensuring the stability of the spine; (4) the patient can perform early leg raising, bed mobility and low back muscle exercise; and (5) lower cost of the procedure. Percutaneous total foraminoscopic disc removal is currently the best procedure for the treatment of lumbar disc herniation in adolescents. Professor Fu Qiang of the Minimally Invasive Spine Center of Changhai Hospital was the first to apply foraminoscopic techniques for the treatment of lumbar disc herniation in adolescents in the Shanghai area. He has operated on dozens of adolescents from all over China and Asia with satisfactory results. The clinical manifestations of lumbar disc herniation in adolescents are quite different from those of the adult type. It is characterized by fewer and milder symptoms and relatively more and heavier signs. Trauma, disc degeneration and congenital developmental abnormalities are the most important causes of lumbar discs in adolescents. At present, conservative treatment is the first and necessary treatment for adolescent lumbar disc herniation; secondly, open and fixed fusion surgery is traumatic and expensive, and its indications should be strictly mastered; minimally invasive techniques such as MED and intervertebral foraminoscopy have the advantage of less trauma and are the first choice and development trend for the treatment of adolescent lumbar disc herniation in the future. However, their equipment is complex and expensive, technically difficult, and the learning curve is long, so the promotion and popularization of the surgical techniques still need some time.