Dimar John R, Glassman Steven D, Carreon Leah Y
Kenton D. Leatherman Spine Center, University of Louisville School of Medicine, Louisville, KY 40202, USA.
Spine J. 2007 May-Jun;7(3):332-7. doi: 10.1016/j.spinee.2006.03.008. Epub 2007 Jan 24.
Persistent low back pain in the young remains a significant diagnostic and treatment challenge for clinicians. Traditionally, chronic low back pain in this population has been attributed to either serious undetected pathology or psychosocial etiologies. This assumption may be incorrect because patients in this population may have underlying juvenile degenerative disc disease (JDDD), an important pathological diagnosis in the adult population.
The purpose of this study is to report the presentation, radiographic findings, diagnosis, and treatment modalities of juvenile patients presenting with persistent low back pain for greater then 6 months.
This is a retrospective review of patients less than 21 years old referred to a spine specialty practice with persistent low back pain.
The charts of 1,877 patients less than 21 years old referred to a spine specialty practice for the evaluation of spinal problems.
Magnetic resonance images (MRI) were obtained and reviewed by a neuroradiologist and two orthopedic surgeons.
Patients younger than 21 years old with persistent low back pain for greater that 6 months were identified. Patients with scoliosis, Scheuermann's kyphosis, spondylolisthesis, fracture, tumor, and metabolic bone disease were excluded. Standard demographic information, relevant medical history and physical examination findings were collected. Patients were evaluated with an MRI of their spines to detect any potential underlying pathology. The success of various treatment modalities used was reviewed. The findings of this study were correlated to those of the available literature following a thorough review.
Seventy-six patients (34 males, 42 females) with degenerative disc disease were identified on MRI. The mean age was 17.1 years (range 11.5-21.0) with a mean body mass index (BMI) of 24.5 (range 17.7-35.4). Thirty-one had associated radiculopathy. There was 11 smokers, 20 involved in athletics, 17 with co-morbidities, and 9 with a BMI greater than 30. A distinct subgroup of 13 patients with multilevel concurrent spinal stenosis was documented. Four of this subgroup required surgical intervention for severe radicular or claudication symptoms. The majority of JDDD patients were successfully treated with nonoperative modalities.
The findings of this study question whether lumbosacral degenerative disc disease, commonly thought to exist only in an older population, in fact begins earlier in selected patients. Our study confirms the findings of others that there is a definite population of juveniles that present with chronic low back pain who have degenerative disc disease identified on MRI. Within this population is a subgroup of patients with concurrent congenital spinal stenosis. Most patients with JDDD appear to be well managed by traditional nonoperative treatment modalities.
年轻人持续的下腰痛仍然是临床医生面临的重大诊断和治疗挑战。传统上，该人群的慢性下腰痛被归因于严重的未被发现的病理状况或社会心理病因。这种假设可能是不正确的，因为该人群的患者可能患有潜在的青少年退行性椎间盘疾病（JDDD），这是成人人群中的一种重要病理诊断。
本研究的目的是报告持续下腰痛超过6个月的青少年患者的临床表现、影像学检查结果、诊断和治疗方式。
这是一项对转诊至脊柱专科门诊的持续下腰痛的21岁以下患者的回顾性研究。
1877名21岁以下因脊柱问题转诊至脊柱专科门诊的患者的病历。
获取磁共振成像（MRI）并由一名神经放射科医生和两名骨科医生进行评估。
确定年龄小于21岁且持续下腰痛超过6个月的患者。排除患有脊柱侧弯、休门氏驼背、椎体滑脱、骨折、肿瘤和代谢性骨病的患者。收集标准人口统计学信息、相关病史和体格检查结果。对患者进行脊柱MRI检查以检测任何潜在的基础病理状况。回顾所采用的各种治疗方式的成功率。在全面回顾后，将本研究的结果与现有文献的结果进行关联。
MRI检查发现76例（34例男性，42例女性）患有退行性椎间盘疾病。平均年龄为17.1岁（范围11.5 - 21.0岁），平均体重指数（BMI）为24.5（范围17.7 - 35.4）。31例伴有神经根病。有11名吸烟者，20名从事体育运动，17例有合并症，9例BMI大于3级。记录了一个由13例多节段并发脊柱狭窄患者组成的独特亚组。该亚组中有4例因严重神经根症状或间歇性跛行症状需要手术干预。大多数JDDD患者通过非手术方式成功治疗。
本研究结果质疑通常认为仅存在于老年人群中的腰骶部退行性椎间盘疾病实际上是否在部分患者中更早开始。我们的研究证实了其他人的发现，即确实有一部分青少年表现为慢性下腰痛，MRI检查发现患有退行性椎间盘疾病。在这一人群中存在并发先天性脊柱狭窄的亚组患者。大多数JDDD患者似乎通过传统的非手术治疗方式得到了良好的管理。
