Minna Erkintalo

Low back pain in the young. A prospective three-year follow-up study of subjects with and without low back pain.

Study Design. This was a prospective 3-year follow-up study of randomized matched subgroups of 15-year-old school children with or without low back pain initially. Objective. In addition to low back pain and leisure time physical activity, spinal mobility, trunk muscle strength, and early degenerative findings of the lumbar spine were evaluated. Summary of Background Data. Reliable epidemiologic studies on the prevalence of low back pain and development of early degenerative changes of the lumbar spine in young persons have been sparse. Along with several other characteristics, the relationship of these changes to frequent low back pain in young persons is not known. Methods. After a questionnaire-based survey was administered, subjects with or without low back pain were examined initially and at follow-up with special reference to leisure time physical activity, anthropometry, spinal mobility, trunk muscle strength, and magnetic resonance imaging findings of the lumbar spine. Results. At baseline and at follow-up, those subjects with initial low back pain were characterized by a low frequency of physical activity and decreased spinal function. During follow-up, the occurrence of disc degeneration increased significantly more in the original group with low back pain than among asymptomatic subjects. Furthermore, disc degeneration at baseline significantly predicted future frequent low back pain. Initial disc protrusion also predicted future frequent low back pain. Conclusion. After the rapid physical growth period, there seemed to be a causal relationship between the early evolution of the degenerative processes of the lower lumbar discs and frequent low back pain in several subjects.

Low-back pain in adolescent athletes

In this 3-yr longitudinal study we investigated the occurrence of low-back pain and anatomic changes in the low back in relation to loading and injuries among 98 adolescents: 33 nonathletes (16 boys, 17 girls), 34 boy athletes (17 ice hockey, 17 soccer players), and 31 girl athletes (17 figure skaters, 14 gymnasts). During the 3-yr follow-up, low-back pain lasting longer than 1 wk was reported by 29 (45%; 95% CI, 32%-57%) athletes and by 6 (18%; 95% CI, 7%-35%) nonathletes (P = 0.0099). Acute back injury was reported by 17 of 19 subjects who also reported low-back pain (89%; 95% CI, 67%-99%) and by 2 of 63 of those without prolonged low-back pain (3%; 95% CI, 0%-11%) (P < 0.0001). Among 43 girls participating in baseline and follow-up MRI examinations of the lumbar spine, new MRI abnormalities were found in 6 of 8 reporting acute back injury (75%; 95% CI, 35%-97%) and in 8 of the remaining 35 girls (23%; 95% CI 10% to 40%) (P = 0.018). In conclusion, excessive loading that involves a risk for acute low-back injuries during the growth spurt is harmful to the lower back.

Magnetic Resonance Study of Disc Degeneration in Young Low-back Pain Patients

The correlation of roentgenographlc findings, clinical history, and Incipient disc degeneration (DD), diagnosed with magnetic resonance imaging, was analyzed in young patients with low-back pain (LBP). One or more lumbar discs were abnormal In 57% of the 20-year-old LBP patients (n=75) and in 35% of the asymptomatic controls (n=34) in MRI. Narrowed disc spaces and alterations attributed to lumbar Scheuermanns disease, shown on the radiographs, were always associated with DD in MRI. Such a strong relationship was not observed with transitional vertebrae, spondylolisthesis, spina bifida, or postural abnormalities. However, an Increased weight, a positive straight leg raising test, and a reduced lumbar mobility was consistent with an increase in frequency of DD. Magnetic resonance imaging is a safe and sensitive method for studying the presence and etlologic factors of DD.

Back extensor and psoas muscle cross-sectional area, prior physical training, and trunk muscle strength : a longitudinal study in adolescent girls

Abstract The association between physical training, low back extensor (erector spinae plus multifidus muscles) and psoas muscle cross-sectional areas (CSA) and strength characteristics of trunk extension and flexion were studied in adolescent girls. A group of athletes (n=49) (age range 13.7–16.3 years) consisting of gymnasts, figure skaters and ballet dancers was age-matched with non-athletes (n=17) who acted as a sedentary control group. The CSA of psoas muscles and multifidus plus erector spinae muscles were measured from lumbar axial images by magnetic resonance imaging. Maximal trunk extension and flexion forces were measured in a standing position using a dynamometer and trunk musculature endurance was evaluated using static holding tests. When CSA were adjusted with body mass, the athletes showed significantly greater CSA in both muscles studied (psoas P < 0.001; erector spinae plus multifidus P < 0.05) than the non-athletes. The athletes also had a greater absolute psoas muscle CSA (P < 0.01) and trunk flexion force (P < 0.01) compared to the controls. When the forces were expressed relative to body mass, the athletes were superior both in trunk flexion (P < 0.001) and extension (P < 0.001). There was a significant correlation between muscle CSA and strength parameters, but the force per muscle CSA did not differ significantly between the athletes and the non-athletes. In addition, the athletes showed a better body mass adjusted muscle endurance in trunk flexion (P < 0.05) than the non-athletes. Our study indicated that regular physical training enhances trunk musculature hypertrophy, force and endurance in adolescent girls, and that there is an association between muscle CSA and strength parameters.

Disc degeneration in scheuermann disease

Comparison of the radiographic signs of Scheuermann disease and the corresponding disc degeneration on thoracolumbar magnetic resonance (MR) images was made in 21 young patients. Marginal sclerosis, Schmorl nodes and narrowed disc spaces, but not irregular or wedge-shaped end-plates, were significantly associated with disc degeneration. Fifty-five percent of the discs in the patients with Scheuermann disease were abnormal on MRI, compared with 10% in asymptomatic controls. Our study confirms that thoracolumbar disc degeneration is enhanced in 20-year-old patients with low back pain who have radiological evidence of Scheuermann disease.

Postoperative hematomas after successful lumbar microdiscectomy or percutaneous nucleotomy: a magnetic resonance imaging study.

We evaluated the incidence of postoperative extradural hematomas by means of magnetic resonance imaging (MRI) technique in 44 patients who underwent successful surgery for a virgin lumbar disc herniation. Of these patients, 28 were treated with microdiscectomy and 16 with percutaneous nucleotomy. Postoperative hematoma proved to be a universal MRI finding in the microsurgically treated patients: hematomas were found in all patients in the microdiscectomy group. In 12 (43%) patients the hematoma extended into the dural sack. The incidence of hematomas was significantly (p = 0.001) lower in the patients treated with percutaneous nucleotomy: hematomas were detected in only 10 (63%) of the 16 patients in the nucleotomy group. The hematomas in these patients were also smaller in size and none of them connected with the dural sac. Correlation between the hematomas and clinical findings showed that the presence of a hematoma had no obvious effect on the immediate postoperative recovery of a patient.

Magnetic resonance image changes and clinical outcome after microdiscectomy or nucleotomy for ruptured disc

Preoperative and postoperative magnetic resonance imaging (MRI) of the lumbar spine was performed on 41 patients treated either microsurgically or with percutaneous nucleotomy for lumbar disc herniation. On the first postoperative day, MRI revealed an edematous mass effect at the level of surgery in 25 (61%) patients. The mass effect caused compression of the anterior dural sac mimicking preoperative disc herniation. After the follow-up of 6 months, the mass effect had disappeared in all patients, and the MRI finding in the operated disc space was that of a prolapse in six (15%) patients and that of a protrusion in 16 (39%) patients. Postoperative scarring was detected in 23 (56%) patients. The amount of the epidural scar tissue was significantly (p = 0.0002) associated with the extent of the early postoperative hemorrhagic changes detected in these patients with MRI. No association was observed between these MRI findings (mass effect, disc herniation, epidural scarring) and the clinical outcome of the patients.

Disc degeneration and lumbar instability. Magnetic resonance examination of 16 patients.

Flexion and extension radiographs of 75 young males with low back pain disclosed abnormal segmental motion of the lumbar spine in 16 patients with translational movements in 20 intervertebral segments. These 16 patients were further investigated by magnetic resonance imaging to assess disc degeneration in the unstable segments. On T2-weighted images of the 20 segments, the disc was normal in 13 and degenerated in only 7 patients. Thus, the initial factor in lumbar instability in young patients with low back pain is not always degeneration of the disc.

Neck muscles cross‐sectional area in adolescents with and without headache – MRI study

Background: Cervical musculature may play an important role in the genesis of tension‐type headache. However, there are no reports on a possible association between the morphometrical features of the neck flexion and extension muscles and adolescence headache.

Adolescent Disc Degeneration - No Headache Association

The objective of the study was to determine whether adolescents with headache have more disc degeneration in the cervical spine than headache-free controls. This study is part of a population-based follow-up study of adolescents with and without headache. At the age of 17 years, adolescents with headache at least three times a month (N = 47) and adolescents with no headache (N = 22) participated in a magnetic resonance imaging (MRI) study of the cervical spine. Of the 47 headache sufferers, 17 also had weekly neck pain and 30 had neck pain less than once a month. MRI scans were interpreted independently by three neuroradiologists. Disc degeneration was found in 67% of participants, with no difference between adolescents with and without headache. Most of the degenerative changes were located in the lower cervical spine. In adolescence, mild degenerative changes of the cervical spine are surprisingly common but do not contribute to headache.