Sympathetic Sibling Disc Herniation: A Case Report
PM & R
Case Diagnosis: Sympathetic Sibling Disc Herniation: a case report Case Description: The first patient presented at 20 years old (2018) after transient episode of left leg pain which resolved spontaneously. A year later while walking on treadmill, he spontaneously had radicular right-sided pain in L5-S1 distribution. He denied red flag symptoms including bowel/bladder changes or saddle anesthesia. He developed progressive neurologic deficits which led to MRI L-spine showing L5-S1 central disc extrusion with severe narrowing. The above patient’s younger sister presented at 16 years old (2019) with radicular LBP. She initially went to chiropractor with improvement. Radiographs of lumbosacral spine showed mild degenerative disc disease at L4-5, L5-S1. A few months later, she had acutely worsening LBP after field hockey practice while reaching for a ball, but no other trauma. She had pain in right posterior thigh without paresthesias or weakness. She trialed conservative management with steroids, muscle relaxers, and PT, and temporary cessation from sports. Symptoms didn’t improve; MRI showed large central posterior disc herniations at L4-5, L5-S1, most severe at L5-S1. Of note, a cousin frequently in close proximity to the siblings developed the same symptoms. She too failed conservative management and MRI L-spine showed L5-S1 disc herniation; she ultimately underwent L5-S1 bilateral discectomy. Setting: Tertiary care hospital Assessment/Results: The first patient underwent posterior L5-S1 bilateral discectomy. The second underwent L5-S1 lumbar microdiscectomy. Both had complete resolution of symptoms afterwards. Discussion: Symptomatic lumbar disc herniation is rare in children. These cases illustrates an unusual pathology in adolescents, but is more peculiar given there was no clear inciting event and the closeness in time frame of acute onset. Conclusion: Studies suggest possible inheritable predisposition for development in first-degree relatives. These cases highlight a possible genetic component causing herniation at a young age, but further studies should investigate alternative variables such as environmental or emotional factors that are underrecognized. Level of Evidence: Level IV
Bazil T, Chamberlain C, LaBan M M. Sympathetic sibling disc herniation: a case report. 2021 Nov 19; PM & R 13(S1):S102.