Abstract
Background: Herniated nucleus pulposus is infrequent among children and adolescents. The first case of surgical intervention for disc herniation was reported in a 12-year-old child. Since then, very few cases or series of cases have been published. The current case report is of a 15-year-old girl with no history of spinal ailment, who presented with a large disc herniation in the L4–L5 region, associated with reactive secondary scoliosis and resolved following a successful surgical intervention.
 Case Description: A 15-year-old female with a known case of scoliosis and a history of lower back pain for nine months following a fall while playing football, without any past account of the spinal disease, was presented at the outpatient clinic. After a series of proper imaging, a large L4/5 HNP with positional secondary scoliosis was diagnosed. However, due to the persistence of symptoms for more than two months in radiculopathy and reactive scoliosis, the decision was made to proceed with L4/5 microscopic discectomy. After six months, the neurological examination was normal, with a significant improvement of scoliosis with the restoration of normal spine alignment seen in plain X-ray films. The right leg radiculopathy improved as well.
 Conclusion: Lumbar disc herniation in association with scoliosis needs a vigilant evaluation of signs and symptoms and appropriate diagnostic imaging. Imaging is vital in diagnosing underlying disease states and helps in clinical management and surgical planning. The appropriate treatment is a discectomy.
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