An Epidemiologic Study of MRI and Low Back Pain in 13-Year-Old Children.

Per Kjaer, PT, MSc, PhD; Charlotte Leboeuf-Yde, DC, MPH, PhD; Joan Solgaard Sorensen MD; Tom Bendix, MD, PhD

Disclosures

Spine. 2005;30(7):798-806. 

In This Article

Abstract and Introduction

Study Design: Cross-sectional cohort study of a general population.
Objective: To describe associations between abnormal lumbar magnetic resonance imaging (MRI) findings and low back pain (LBP) in 13-year old children.
Summary and Background Data: Very little is known about the distribution of lumbar MRI findings and how they are associated with LBP in youngsters.
Methods: Disc abnormalities, as well as nerve root compromise, endplate changes, and anterolisthesis were identified from MRI studies of 439 children. LBP was identified from structured interviews. Associations are presented as odds ratios (OR).
Results: Signs of disc degeneration were noted in approximately 1/3 of the subjects. Reduced signal intensity and irregular nucleus shape in the upper 3 lumbar discs were significantly associated with LBP within the last month (OR, 2.5-3.6), whereas reduced signal intensity and disc protrusion at L5-NS1 were associated with seeking care (OR, 2.8 and 7.7, respectively). Endplate changes in relation to the L3 discs were associated with LBP month and seeking care (OR, between 9.7 and 22.2). Anterolisthesis at L5 was associated with seeking care (OR, 4.3). There were obvious differences between genders: degenerative disc changes in the upper lumbar spine were more strongly associated with LBP in boys, while disc abnormalities in the lower lumbar spine were more strongly associated with seeking care in girls.
Conclusions: In children, degenerative disc findings are relatively common, and some are associated with LBP. There appears to be a gender difference. Disc protrusions, endplate changes, and anterolisthesis in the lumbar spine were strongly associated with seeking care for LBP.

Low back pain (LBP) is relatively common in young individuals.[1,2,3] Studies have shown that LBP often begins in childhood and during the early teenage years.[4,5,6] Causes of LBP in children and adolescents are often not known. However, because almost all lumbar structures can elicit pain,[7] it is reasonable to assume that morphologic changes of the lumbar spine play a role in LBP. Different types of endplate changes (Scheuermann disease, Schmorl nodes) have previously been described in relation to LBP in children and adolescents,[8] and disc herniations have also been found.[9] To identify abnormalities in young lumbar spines, it is necessary to define the limits of normality. This process remains difficult because our knowledge of spinal morphology, development, and degeneration in children and adolescents is rather limited. This is to a large degree due to the fact that there are no studies involving the general population. Cadaver studies show that a clear distinction between the anulus and the nucleus should be expected in children and adolescents,[10] even though the nucleus already becomes more fibrous during this period.[11,12,13,14]

Magnetic resonance imaging (MRI) studies are useful sources of information regarding lumbar spinal anatomy in humans. However, only 3 cross-sectional case control studies,[9,15,16] and one longitudinal study[17,18,19,20] involving a total of 171 symptomatic individuals and 202 controls involving adolescents are available. These studies show that disc degeneration and herniations are more common in patients with LBP compared to controls, while the frequency of MRI findings of reduced disc height does not differ. Surprisingly, in one study,[15] disc degeneration was more prevalent in the control group, while disc degeneration was highly predictive of recurrent LBP in another study.[20] Because these results were based on small case control studies, it is necessary to continue this work in a large study sample from the general population.

The purpose of the study was to describe the self-reported prevalence of LBP and the seeking of care for LBP in 13-year-old children, the prevalence of certain MRI findings in the lumbar spine, and to evaluate any possible associations between LBP/care seeking and the MRI findings. Therefore, a 3-year prospective study was designed, and the baseline data are presented in the present report.

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