*Department of Orthopaedic Surgery, University of California, San Diego, CA †Rady Children's Hospital and Health Center, Department of Orthopaedic Surgery, San Diego, CA ‡Department of Radiology, Rady Children's Hospital and Health Center, University of California, San Diego, CA §University of California, Clinical and Translational Research Institute, Biostatistics Core, San Diego, CA ¶University of California, Division of Biostatistics and Bioinformatics, San Diego, CA.
Spine (Phila Pa 1976). 2014 Feb 1;39(3):243-8. doi: 10.1097/BRS.0000000000000114.
STUDY DESIGN: This study is a repeated measures design to measure the lumbar spine's response to common backpack loads in children with idiopathic low back pain (ILBP) using upright magnetic resonance imaging (MRI). OBJECTIVE: The purpose of this study is to analyze the lumbar spine's response to backpack loads with upright MRI in children with ILBP to compare their results with previously published normal child data under the same conditions. We hypothesize that typical backpack loads will have a different effect on the lumbar spine of normal children and children with ILBP. SUMMARY OF BACKGROUND DATA: Research in normal children shows that backpack loads compress the lumbar intervertebral discs (IVDs), increase lumbar coronal deformity, and increase pain. METHODS: Fifteen pediatric and adolescent patients with ILBP were selected. Patients were excluded if a spinal deformity, an underlying pathology, or known injury was identified. A 0.6-T upright MRI scanner imaged the subjects while in supine and standing positions wearing 0-kg, 4-kg, and 8-kg backpacks. IVD height, lumbar lordosis, lumbar coronal deformity, and pain score were recorded after each condition and compared using analysis of variances. We compared the above-mentioned variables between ILBP and normal subjects using generalized least squares models. RESULTS: The cohort's mean age was 13 ± 3 years. The 4-kg and 8-kg backpacks only compressed the L5-S1 IVD relative to upright with no load. Subjects experienced increasing pain with increasing load. Load had no effect on lumbar lordosis or lumbar coronal deformity. Compared with normal children, children with ILBP experience significantly less disc compression at T12-L1 to L4-L5, less lumbar lordosis, and more pain with increasing load. CONCLUSION: In children with ILBP, increasing backpack load compresses only the L5-S1 IVD. Compared with normal children, children with ILBP experience less lumbar IVD compression, less lumbar lordosis, and more pain due to increasing load suggesting altered mechanisms for load tolerance in children with ILBP. LEVEL OF EVIDENCE: 3.
研究设计：本研究采用重复测量设计，使用直立磁共振成像（MRI）测量特发性下腰痛（ILBP）儿童对常见背包负荷的腰椎反应。 研究目的：本研究旨在通过直立 MRI 分析 ILBP 儿童背包负荷对腰椎的影响，并将其结果与相同条件下已发表的正常儿童数据进行比较。我们假设，典型的背包负荷对正常儿童和 ILBP 儿童的腰椎会产生不同的影响。 背景资料总结：对正常儿童的研究表明，背包负荷会压缩腰椎间盘（IVD），增加腰椎冠状畸形，并增加疼痛。 方法：选择 15 名患有 ILBP 的儿科和青少年患者。如果发现脊柱畸形、潜在病理或已知损伤，则排除患者。使用 0.6-T 直立 MRI 扫描仪在仰卧位和站立位对受试者进行成像，同时穿着 0-kg、4-kg 和 8-kg 的背包。在每种情况下记录 IVD 高度、腰椎前凸、腰椎冠状畸形和疼痛评分，并使用方差分析进行比较。我们使用广义最小二乘法模型比较 ILBP 和正常受试者之间的上述变量。 结果：队列的平均年龄为 13 ± 3 岁。与无负荷时相比，只有 4-kg 和 8-kg 的背包会压缩 L5-S1 IVD。随着负荷的增加，受试者的疼痛也随之增加。负荷对腰椎前凸或腰椎冠状畸形没有影响。与正常儿童相比，ILBP 儿童在 T12-L1 到 L4-L5 处的椎间盘压缩程度更小，腰椎前凸度更小，随着负荷的增加疼痛程度更大。 结论：在患有 ILBP 的儿童中，增加背包负荷只会压缩 L5-S1 IVD。与正常儿童相比，ILBP 儿童由于负荷增加而导致腰椎 IVD 压缩程度更小、腰椎前凸度更小、疼痛程度更大，这表明 ILBP 儿童对负荷耐受的机制发生了改变。 证据水平：3。
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