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One radiologist and one neurosurgeon jointly made diagnostic decisions. We classified adolescent LDH into four groups of herniation severity as is required by the guideline issued by the Korean military directorate, as shown in Fig. 1 and Table 1. According to the guideline, medical conditions are assigned to seven Military Manpower Administration (MMA) physical grades. Normal disc with no signal change in MRI and no disrupted disc material was defined as physical grade 1. Mild disc bulging without compression of thecal sac check details was considered as grade 2 (Fig. 1A, 1B). Disc protrusion or extrusion without compression of thecal sac was classified to grade 3 (Fig. 1C, 1D). Disc protrusion or extrusion with compression of thecal sac was considered to grade 4 (Fig. 1E, 1F). If thecal sac compression was ambiguous, additional electoromyogram test was applied to examinees. A positive electromyogram test was defined as matched radiculopathy finding in terms of the level suspicious for herniation.; Disc protrusion or extrusion with canal compromise more than 50% at the mid-sagittal diameter (front to back) in the same plane was defined as grade 5 Hormones antagonist (Fig. 1G). Disc protrusion or extrusion with positive cut-off sign, the loss of neuromuscular signal at the level of interest identified by imaging, was also classified as grade 5 (Fig. 1H). Fig. 1 Images of categories of adolescent herniated lumbar discs in accordance with the guideline issued by the Korean military medical directorate. Mild disc bulging without compression of thecal sac was considered as grade 2 (A, B). Disc protrusion or extrusion ... Table 1 Classification of adolescent herniated lumbar disks as required by guideline issued by the Korean military medical directorate For the purposes of the present study, Alizarin grade 1-2 was considered mild herniation, grade 3 as moderate herniation, grade 4 as severe herniation, grade 5-6 as very severe herniation, and grade 7 as considered as the necessary of recheck about the physical condition. A history of simple discectomy or of a spinal procedure was not considered, and preoperative herniation severities were used to confirm MMA grades. Subjects with other spinal diseases, such as, ankylosing spondylitis, spondylolisthesis, spondylolysis, Shermann's nodules, limbus fractures, lumbarization, and scoliosis, were excluded from the study. The prevalences of adolescent LDH were analyzed according to the guideline issued by the Korean military directorate herniation severities. Level of herniation distribution was also determined. The relation between Modified Korean Oswestry low back pain scores and MMA grades was analyzed. Statistical significances between herniation severity groups were examined by simple linear regression analysis. Tests were considered significant when p-values were