Lund Teija, Ristolainen Leena, Kautiainen Hannu, Lohman Martina, Schlenzka Dietrich
Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland.
Research Institute Orton, Orton Orthopaedic Hospital, Tenholantie 10, 00280 Helsinki, Finland.
Spine J. 2025 Feb;25(2):317-323. doi: 10.1016/j.spinee.2024.09.013. Epub 2024 Sep 25.
Low back pain (LBP) among children and adolescents is a growing global concern. Disc degeneration (DD) is considered a significant factor in the clinical symptom of LBP. Both LBP and DD become more prevalent as adolescents transition into emerging adulthood. However, the relationship between growth during the pubertal growth spurt and the morphology of lumbar discs has yet to be elucidated.
This study aimed to assess the relationship between bodily growth during the pubertal growth spurt and the morphology of lumbar discs at age 18.
This study was a prospective longitudinal cohort study.
A randomly selected cohort of healthy children was examined at ages 8, 11, and 18. Participants with complete data sets (semi-structured interview, anthropometric measurements and lumbar spine MRI) at age 11 and 18 were included in this analysis (n=59).
The morphological characteristics of lumbar discs were evaluated on MRI. Anthropometric measures including height, sitting height and weight were obtained to calculate the Body Surface Area (BSA) and the Body Mass Index (BMI).
The morphology of the lumbar discs was evaluated on T2-weighted midsagittal MRI using the Pfirrmann classification. A disc with a Pfirrmann grade of 3 or higher was considered degenerated at age 18. The relationship between relative growth between ages 11 and 18 (adjusted to sex and baseline values) and DD at age 18 was assessed. To analyze the relationship between the relative increase in BSA and DD, the participants were categorized into three equal-sized categories (tertiles). For all other anthropometric measures, the analysis was based on the relative increase in each measure between ages 11 and 18.
In the highest tertile of relative increase in BSA (≥43%), 76% of participants had at least 1 disc with a Pfirrmann grade 3 or higher at age 18 while only 10% and 21% of participants in the lowest and medium tertiles had DD, respectively. The sex- and baseline-adjusted odds ratio (OR) for DD at age 18 for every additional 10% increase in BSA was 1.08 (1.02-1.15). The sex- and baseline-adjusted OR (95% CI) for DD at age 18 was 10.5 (1.60-68.7) and 7.92 (1.19-52.72) with every additional 10% increase in height and sitting height, respectively. For every additional 10% increase in weight, the adjusted OR for DD at age 18 was 1.51 (1.12-2.04) and for BMI 1.05 (1.01-1.09).
More relative growth between ages 11 and 18 is significantly associated with the occurrence of DD in emerging adulthood. Among the measures investigated, height and sitting height are nonmodifiable. Maintaining an ideal body weight during the pubertal growth spurt may be beneficial for the health of the lumbar discs.
儿童和青少年的腰痛（LBP）是一个日益受到全球关注的问题。椎间盘退变（DD）被认为是腰痛临床症状的一个重要因素。随着青少年步入成年早期，LBP和DD都变得更加普遍。然而，青春期生长突增期间的生长与腰椎间盘形态之间的关系尚未阐明。
本研究旨在评估青春期生长突增期间的身体生长与18岁时腰椎间盘形态之间的关系。
本研究是一项前瞻性纵向队列研究。
随机选取一组健康儿童，在8岁、11岁和18岁时进行检查。本分析纳入了在11岁和18岁时拥有完整数据集（半结构化访谈、人体测量和腰椎MRI）的参与者（n = 59）。
通过MRI评估腰椎间盘的形态特征。获取包括身高、坐高和体重在内的人体测量指标，以计算体表面积（BSA）和体重指数（BMI）。
使用Pfirrmann分类法在T2加权矢状位MRI上评估腰椎间盘的形态。Pfirrmann分级为3级或更高的椎间盘在18岁时被认为发生了退变。评估11岁至18岁之间的相对生长（根据性别和基线值进行调整）与18岁时DD之间的关系。为了分析BSA相对增加与DD之间的关系，将参与者分为三个大小相等的类别（三分位数）。对于所有其他人体测量指标，分析基于11岁至18岁之间各指标的相对增加。
在BSA相对增加最高的三分位数（≥43%）中，76%的参与者在18岁时至少有1个椎间盘Pfirrmann分级为3级或更高，而在最低和中等三分位数中，分别只有10%和21%的参与者发生了DD。BSA每增加10%，18岁时DD的性别和基线调整后的优势比（OR）为1.08（1.02 - 1.15）。身高和坐高每增加10%，18岁时DD的性别和基线调整后的OR（95%CI）分别为10.5（1.60 - 68.7）和7.92（1.19 - 52.72）。体重每增加10%，18岁时DD的调整后OR为1.51（1.12 - 2.04），BMI每增加10%，调整后OR为1.05（1.01 - 1.09）。
11岁至18岁之间更多的相对生长与成年早期DD的发生显著相关。在所研究的指标中，身高和坐高是不可改变的。在青春期生长突增期间保持理想体重可能有利于腰椎间盘的健康。
