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•Minimally invasive surgical approaches are safe treatments for paediatric lumbar disc herniation.•No particular surgical approach shows clear superiority of outcomes.•Lumbosacral anatomic variants likely predispose patients to disc herniation.•Surgery for lumbar disc herniation is equally or more efficacious for paediatric patients in comparison with adults. Lumbar disc herniation (LDH) is a rare cause of morbidity in the paediatric population that can result in disruption to education and participation in social and athletic activities. Modern minimally invasive techniques have increasingly been adopted in paediatric spine surgery. The purpose of this review was to assess characteristics of paediatric LDH, evaluate current surgical techniques and their outcomes in recent literature, and compare paediatric outcomes with adults. A literature search was carried out identifying articles published from 2008 to 2018 relating to surgical treatment of LDH in children and adolescents. Original articles were scrutinised for outcome data and complications then compared by surgical approach. Over the last decade 1094 surgical cases have been published, mostly L4/L5 (52%) and L5/S1 (41%) intervertebral discs. These were predominantly operated with microdiscectomy and minimally invasive techniques: percutaneous endoscopic and tubular approaches to discectomy. Cystic fibrosis, trauma, extensive athletic activity, facet joint asymmetries and lumbosacral transition vertebrae may be risk factors for LDH. 55% had total resolution of pain after surgery, complications are rare and unsatisfactory resolution of pain and re-operation uncommon. In the short and medium-term, overall, paediatric patients do not have worse surgical outcomes than adult patients; they may recover faster and improve more. Minimally invasive approaches for LDH in adolescents are safe and efficacious. No technique has yet demonstrated clear superiority. Delaying surgery for conservative treatment is warranted, but for how long remains unclear.

Infarction of the insula is a common scenario with large tissue-volume strokes in the middle cerebral artery territory. Considered to be part of the central autonomic network, infarction of this region is associated with autonomic disturbances, in particular cardiovascular dysregulation. Risk of aspiration following stroke is also associated with involvement of the insula, consistent with its purported participation in complex functions of the mouth and pharynx. Strokes restricted to the insula are rare and present with a broad range of symptoms that offer a window of insight into the diverse functionality of the insular cortex. Chemosensory, autonomic, vestibular, auditory, somatosensory, language and oropharyngeal functional deficits are all recognised, among others. Long-term sequelae are unknown but profound symptoms, such as hemiparesis, are usually transient. Understanding the patterns of dysfunction highlighted provides the basis for future strategies to optimise stroke management on the discovery of insula involvement.