Department of Orthopaedic Surgery, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA; The International Spine Research and Innovation Initiative, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA.
The International Spine Research and Innovation Initiative, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA.
Spine J. 2023 Jul;23(7):945-953. doi: 10.1016/j.spinee.2023.03.008. Epub 2023 Mar 22.
Low back pain (LBP) is common in children and adolescents, carrying substantial risk for recurrence and continuation into adulthood. Studies have linked obesity to the development of pediatric LBP; however, its association with lumbar spine degeneration, alignment parameters, and opioid use remains debated.
Considering the increasing prevalence of pediatric obesity and LBP and the inherent issues with opioid use, this study aimed to assess the association of obesity with lumbar spine degeneration, spinopelvic alignment, and opioid therapy among pediatric patients.
STUDY DESIGN/SETTING: A retrospective study of pediatric patients presenting to a single institute with LBP and no history of spine deformity, tumor, or infection was performed.
A totasl of 194 patients (mean age: 16.7±2.3 years, 45.3% male) were included, of which 30 (15.5%) were obese.
Prevalence of imaging phenotypes and opioid use among obese to nonobese pediatric LBP patients. Magnetic resonance and plain radiographic imaging were evaluated for degenerative phenotypes (disc bulging, disc herniation, disc degeneration [DD], high-intensity zones [HIZ], disc narrowing, Schmorl's nodes, endplate phenotypes, Modic changes, spondylolisthesis, and osteophytes). Lumbopelvic parameters including lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence and pelvic incidence-lumbar lordosis (PI-LL) mismatch were also examined.
Demographic and clinical information was recorded, including use of opioids. The associations between obesity and lumbar phenotypes or opiod use were assessed by multiple regression models.
Based on multivariate analysis, obesity was significantly associated with the presence of HIZ (adjusted OR: 5.36, 95% CI: 1.30 to 22.09). Further analysis demonstrated obesity (adjusted OR: 3.92, 95% CI: 1.49 to 10.34) and disc herniation (OR: 4.10, 95% CI: 1.50 to 11.26) were associated with opioid use, independent of duration of symptoms, other potential demographic determinants, and spinopelvic alignment.
In pediatric patients, obesity was found to be significantly associated with HIZs of the lumbar spine, while disc herniation and obesity were associated with opioid use. Spinopelvic alignment parameters did not mitigate any outcome. This study underscores that pediatric obesity increases the risk of developing specific degenerative spine changes and pain severity that may necessitate opioid use, emphasizing the importance of maintaining healthy body weight in promoting lumbar spine health in the young.
儿童和青少年中常见腰痛（LBP），其复发和持续至成年的风险很高。研究表明肥胖与小儿 LBP 的发展有关；然而，其与腰椎退变、脊柱骨盆排列参数和阿片类药物使用的相关性仍存在争议。
鉴于小儿肥胖和 LBP 的患病率不断增加，以及阿片类药物使用的固有问题，本研究旨在评估肥胖与小儿患者腰椎退变、脊柱骨盆排列和阿片类药物治疗之间的关系。
研究设计/地点：对在一家机构就诊的腰痛且无脊柱畸形、肿瘤或感染史的小儿患者进行了一项回顾性研究。
共纳入 194 例患者（平均年龄 16.7±2.3 岁，45.3%为男性），其中 30 例（15.5%）为肥胖。
肥胖和非肥胖小儿 LBP 患者的影像学表型和阿片类药物使用的患病率。评估磁共振和普通 X 线成像的退行性表型（椎间盘膨出、椎间盘突出、椎间盘退变[DD]、高信号区[HIZ]、椎间盘狭窄、许莫氏结节、终板表型、Modic 改变、脊椎滑脱和骨赘）。还检查了腰椎骨盆参数，包括腰椎前凸、骨盆倾斜、骶骨倾斜、骨盆入射角和骨盆入射角-腰椎前凸（PI-LL）不匹配。
记录人口统计学和临床信息，包括阿片类药物的使用。通过多元回归模型评估肥胖与腰椎表型或阿片类药物使用之间的关系。
基于多变量分析，肥胖与 HIZ 的存在显著相关（调整后的 OR：5.36，95%CI：1.30 至 22.09）。进一步的分析表明，肥胖（调整后的 OR：3.92，95%CI：1.49 至 10.34）和椎间盘突出（OR：4.10，95%CI：1.50 至 11.26）与阿片类药物的使用相关，独立于症状持续时间、其他潜在的人口统计学决定因素和脊柱骨盆排列。
在小儿患者中，肥胖与腰椎 HIZ 显著相关，而椎间盘突出和肥胖与阿片类药物的使用相关。脊柱骨盆排列参数不能减轻任何结果。本研究强调，小儿肥胖会增加特定退行性脊柱变化和疼痛严重程度的风险，可能需要使用阿片类药物，这强调了保持健康体重对于促进年轻人腰椎健康的重要性。
