Low back pain in childhood and adolescence: assessment of sports activities

A cross-sectional study that targeted a total of 43,630 pupils in Niigata City, Japan was performed. The objective of the study was to evaluate the association between sports activities and low back pain (LBP) in childhood and adolescence in Japan. Regarding risk factors of LBP, a large number of studies have been conducted that have examined gender differences, height and weight, body mass index, sports time, differences in lifestyle, family history, and mental factors; however, no definitive conclusion has yet been made. A questionnaire survey was conducted using 43,630 pupils, including all elementary school pupils from the fourth to sixth grade (21,893 pupils) and all junior high pupils from the first to third year (21,737 pupils) in Niigata City (population of 785,067). 26,766 pupils who were determined to have valid responses (valid response rate 61.3%) were analyzed. Among the 26,766 pupils with valid responses, 2,591 (9.7%) had LBP at the time of the survey, and 8,588 (32.1%) had a history of LBP. The pupils were divided between those who did not participate in sports activities except the physical education in school (No sports group: 5,486, 20.5%) and those who participated in sports activities (Sports group: 21,280, 79.5%), and the difference in lifetime prevalence between No sports group and Sports group was examined. The odds ratio for LBP according to sports activity was calculated by multiple logistic regression analysis adjusted for gender, age, and body mass index. In addition, the severity of LBP was divided into three levels (Level 1: no limitation in any activity, Level 2: necessary to refrain from participating in sports and physical activities, and Level 3: necessary to be absent from school), and Levels 2 and 3 were defined as severe LBP; the severity was compared between No sports group and Sports group and in each sport’s items. Moreover, in Sports group, the amount of time spent participating in sports activities were divided into three groups (Group 1: less than 6 h per week, Group 2: 6–12 h per week, and Group 3: 12.1 h per week or more), and the dose–response between the amount of time spent participating in sports activities and the occurrence of LBP were compared. In No sports group, 21.3% experienced a history of LBP; in Sports group, 34.9% experienced LBP (P < 0.001). In comparison to No sports group, the odds ratio was significantly higher for Sports group (1.57), and also significantly higher for most of the sports items. The severity of LBP was significantly higher in Sports group (20.1 vs. 3.2%, P < 0.001). The amount of time spent participating in sports activities averaged 9.8 h per week, and a history of LBP significantly increased in the group which spent a longer time participating in sports activities (odds ratio 1.43 in Group 3). These findings suggest that sports activity is possible risk factors for the occurrence of LBP, and it might increase the risk for LBP in childhood and adolescence.     

Low back pain in childhood and adolescence: a cross-sectional study in Niigata City

A cross-sectional study targeted a total of 43,630 pupils in Niigata City, Japan was performed. The objective was to clarify the present incidence of low back pain (LBP) in childhood and adolescence in Japan. It has recently been recognized that LBP in childhood and adolescence is also as common a problem as that for adults and most of these studies have been conducted in Europe, however, none have so far been made in Japan. A questionnaire survey was conducted using 43,630 pupils, including all elementary school students from the fourth to sixth grade (21,893 pupils) and all junior high students from the first to third year (21,737 pupils) in Niigata City (population of 785,067) to examine the point prevalence of LBP, the lifetime prevalence, the gender differences, the age of first onset of LBP in third year of junior high school students, the duration, the presence of recurrent LBP or not, the trigger of LBP, and the influences of sports and physical activities. In addition, the severity of LBP was divided into three levels (level 1: no limitation in any activity; level 2: necessary to refrain from participating in sports and physical activities, and level 3: necessary to be absent from school) in order to examine the factors that contribute to severe LBP. The validity rate was 79.8% and the valid response rate was 98.8%. The point prevalence was 10.2% (52.3% male and 47.7% female) and the lifetime prevalence was 28.8% (48.5% male and 51.5% female). Both increased as the grade level increased and in third year of junior high school students, a point prevalence was seen in 15.2% while a lifetime prevalence was observed in 42.5%. About 90% of these students experienced first-time LBP during the first and third year of junior high school. Regarding the duration of LBP, 66.7% experienced it for less than 1 week, while 86.1% suffered from it for less than 1 month. The recurrence rate was 60.5%. Regarding the triggers of LBP, 23.7% of them reported the influence of sports and exercise such as club activities and physical education, 13.5% reported trauma, while 55.6% reported no specific triggers associated with their LBP. The severity of LBP included 81.9% at level 1, 13.9% at level 2 and 4.2% at level 3. It was revealed that LBP in childhood and adolescence is also a common complaint in Japan, and these findings are similar to previous studies conducted in Europe. LBP increased as the grade level increased and it appeared that the point and lifetime prevalence in adolescence are close to the same levels as those seen in the adulthood and there was a tendency to have more severe LBP in both cases who experienced pain for more than 1 month and those with recurrent LBP.     

Predictors of persistent postoperative pain after surgery for idiopathic scoliosis

Purpose:To identify factors contributing to persistent postoperative pain in patients treated surgically for idiopathic scoliosis.Methods:In total, 280 patients aged ten through 25 years at surgery, were identified in the Swedish Spine registry; all having preoperative and postoperative visual analogue scale (VAS) for back pain scores. The patients were divided into a high and low postoperative pain group based on the reported postoperative VAS for back pain scores (by using 45 mm on the 0 mm to 100 mm VAS scale as a cut-off). The patient-reported questionnaire included VAS for back pain, the 3-level version of EuroQol 5-dimensional (EQ-5D-3L) instrument, the EuroQol VAS (EQ-VAS) and the Scoliosis Research Society 22r instrument (SRS-22r). Predictors of postoperative back pain were searched in the preoperative data.Results:The 67 (24%) patients that reported high postoperative VAS back pain (> 45 mm) also reported lower postoperative EQ-5D-3L, EQ-VAS and SRS-22r than patients with low postoperative VAS back pain (all p < 0.001). Two preoperative variables were independently associated with postoperative pain; each millimetre increase in preoperative VAS back pain (on the 0 mm to 100 mm scale) was associated with a higher risk of being in the high postoperative back pain group (odds ratio (OR) 1.03; 95% confidence interval (CI) 1.02 to 1.05) and each 1 point decrease on the preoperative SRS-22r mental health (scale from 1 to 5) was associated with a higher risk of being in the high postoperative back pain group (OR 1.68; 95% CI 1.03 to 2.73).Conclusion:High preoperative back pain and low preoperative mental health are independent predictors of back pain after surgery for idiopathic scoliosis.Level of Evidence:III     

Scoliosis and spine involvement in fibrous dysplasia of bone

Few studies focused on the prevalence of scoliosis and involvement of the spine in patients with fibrous dysplasia (FD) of bone. We examined for FD involvement of the spine and scoliosis in 56 patients affected by FD of bone. Fifty patients were part of a cohort reported in a multicentric study on FD promoted by European Pediatric Orthopedic Society (EPOS) in 1999, and six were new patients. There were 30 females and 26 males (mean age 12.5 years; range 1–42 years). Twenty-three had monostotic FD, 9 polyostotic FD, and 24 McCune-Albright Syndrome (MAS). Scoliosis was observed in 11 cases of polyostotic FD and MAS (33.3%). In seven of the patients with scoliosis (63.3%) spine was involved by FD lesional tissue. FD lesions involved the thoracic or lumbar spine in all patients but one, where cervical spine was also affected. A correlation between scoliosis and either spinal (p < 0.01) or pelvic lesions (p < 0.05) and pelvic obliquity (p < 0.01) was observed. Three of the 11 patients showed familiarity for scoliosis but in 2 of them spine was involved by FD. Scoliosis and spine involvement were never detected in monostotic FD. This study indicates that in FD patients with polyostotic disease (1) the prevalences of FD involvement of the spine and scoliosis are high enough to include spine in the clinico-radiographic survey of these patients, and (2) the involvement of the spine and pelvis by FD lesions and pelvic obliquity are important determinants in the occurrence of scoliosis.     

Halo-股骨髁上牵引对重度脊柱侧凸后路矫形的影响

目的探讨Halo-股骨髁上牵引对重度先天性脊柱侧凸及特发性脊柱侧凸患者后路矫形效果的影响。方法选取60例重度脊柱侧凸患者分为先天性脊柱侧凸组及特发性脊柱侧凸组,每组30例。CS组术前平均冠状面Cobb角、胸椎后凸分别为95．7°及70．2°。IS患者术前平均冠状面Cobb角、胸椎后凸为91．6°及50．6°。平均随访38个月。结果60例患者平均牵引23d,平均牵引重量16kg。IS组患者Halo牵引及后路矫形术后侧凸矫正率分别达39．3％、57．5％,胸椎后凸平均矫正33．7％。CS组Halo牵引及后路矫形术后侧凸矫正率分别达35．3％、45．2％,胸椎后凸平均矫正43．5％。两组患者后路矫形术后侧凸及后凸矫正率差异均有统计学意义（P〈0．05）。4例患者在牵引过程中并发臂丛神经麻痹,神经功能均在2个月内获得完全恢复。结论Halo-股骨髁上牵引可大幅提高脊柱侧凸尤其是特发性脊柱侧凸畸形矫正疗效。     

Epidemiological aspects of scoliosis in a cohort of Japanese patients with Prader-Willi syndrome

Background contextThe prevalence of scoliosis in Prader-Willi syndrome (PWS) is high; however, the prevalence of PWS is rare, with one person in 10,000 to 20,000 affected. The etiology and characteristics of scoliosis associated with PWS remain unidentified. In addition, it is believed that the speedup of growth associated with growth hormone (GH) supplement treatment may influence the deterioration of scoliosis in PWS.PurposeTo investigate scoliosis in Japanese patients with PWS.Study designRetrospective observational study.Patient sampleWe investigated 101 patients (67 men, 34 women) who were followed up from November 2002 to January 2008. All patients were diagnosed using fluorescence in situ hybridization or the methylation test. Of the 101 patients, 80 had an inherited deletion of chromosome 15q11–13 (deletion) and 21 patients had no deletion, including those with uniparental disomy.Outcome measures1) Prevalence of scoliosis; 2) association of scoliosis with GH treatments; 3) association of scoliosis with genotype; 4) clarification of PWS scoliosis characteristics; and 5) analysis of severe PWS scoliosis patients (Cobb angle greater than 40°). Scoliosis for our study was defined as scoliosis with a Cobb angle greater than 10°.MethodsTo investigate PWS-associated scoliosis, we used spinal X-ray examinations. The pattern of scoliosis was classified into three types: primary single lumbar or thoracolumbar curve (Type 1), double curve (Type 2), and primary single thoracic curve (Type 3). For statistical analysis, chi-square tests for the distribution of patients were used (p<.05).Results1) Scoliosis was found in 38.6% (39/101) of patients with PWS. 2) There was no statistical difference in the prevalence of scoliosis between the GH treatment group (32.8%) and the GH nontreatment group (group with no GH treatments) (46.5%) (p=.16, chi-square test). 3) There was no statistical difference in the prevalence of scoliosis between the deletion group (38.8%) and the nondeletion group (38.1%) (p=.84, chi-square test). 4) Scoliosis was classified into three types, according to single or double curve scoliosis and position of scoliosis. The prevalence of these groups was 61.5% for Type 1 (primary single lumbar and thoracolumbar curve), 48.7% for lumbar curve convex on the left side, 28.2% for Type 2 (double curve), and 10.3% for Type 3 (primary single thoracic curve). 5) Severe scoliosis was found in nine patients (8.9%, 9/101). Type 2 was found in 66.7% (6/9) of patients with severe scoliosis. During the follow-up period, two patients changed from Type 1 to Type 2.ConclusionsScoliosis in PWS can be classified into three types. A lumbar curve convex on the left side was found in most patients. In addition, severe deterioration of scoliosis was found in Type 2 patients. Therefore we recommend careful, ongoing observations for patients showing double curve tendencies.     

Bone mineral density in children and young adults with idiopathic scoliosis: a systematic review and meta-analysis

Purpose

Osteoporosis is a risk factor for idiopathic scoliosis (IS) progression, but it is still unclear whether IS patients have bone mineral density (BMD) loss and a higher risk of osteoporosis than asymptomatic people. This systematic review aims to explore the differences in BMD and prevalence of osteoporosis between the IS group and the control group.

Methods

We searched 5 health science-related databases. Studies that were published up to February 2022 and written in English and Chinese languages were included. The primary outcome measures consisted of BMD z score, the prevalence of osteoporosis and osteopenia, and areal and volumetric BMD. Bone morphometry, trabecular microarchitecture, and quantitative ultrasound measures were included in the secondary outcome measures. The odds ratio (OR) and the weighted mean difference (WMD) with a 95% confidence interval (CI) were used to pool the data.

Results

A total of 32 case–control studies were included. The pooled analysis revealed significant differences between the IS group and the control group in BMD z score (WMD −1.191; 95% CI  − 1.651 to −0.732, p  <  0.001). Subgroup analysis showed significance in both female (WMD −1.031; 95% CI −1.496 to −0.566, p  <  0.001) and male participants (WMD −1.516; 95% CI −2.401 to −0.632, p  =  0.001). The prevalence of osteoporosis and osteopenia in the group with IS was significantly higher than in the control group (OR  =  6.813, 95% CI 2.815–16.489, p  <  0.001; OR 1.879; 95% CI 1.548–2.281, p  <  0.000). BMD measures by dual-energy X-ray absorptiometry and peripheral quantitative computed tomography showed a significant decrease in the IS group (all p  <  0.05), but no significant difference was found in the speed of sound measured by quantitative ultrasound between the two groups (p > 0.05).

Conclusion

Both the male and female IS patients had a generalized lower BMD and an increased prevalence of osteopenia and osteoporosis than the control group. Future research should focus on the validity of quantitative ultrasound in BMD screening. To control the risk of progression in IS patients, regular BMD scans and targeted intervention are necessary for IS patients during clinical practice.

     

The result of the author's screening system of scoliosis in elementary and junior-high schools

Since 1978 school screening of scoliosis has been performed every year by the system established by the author consisting of 4 step examinations in Niigata City. The initial examination is carried out with forward bending test associated with swing maneuver by school nurses or school doctors in all school boys and girls from the 4th grade of elementary school to the 3rd grade of junior-high school. The incidence of scoliosis with deformity of more than 20 degrees has been nearly constant ranging from 0.06% to 0.09% in elementary school, and 0.35% to 0.40% in junior-high school. The author compared the number and treatment of the patients of Niigata City seen in our scoliosis clinic in the period of 7 years before and after starting this program. After this program started, the number of the patients with scoliosis of more than 20 degrees has increased by 4 times. The number of surgery in adolescent idiopathic scoliosis, on the contrary, has markedly decreased.     

Back pain and backpacks in school children

OBJECTIVE: Back pain in adults is common and well studied. In contrast, back pain in children has received comparatively little scientific study, despite recent media attention. The purpose of this study is to see what factors influence the prevalence of back pain in middle school children, with particular attention to the weight of children's backpacks and the availability of school lockers. METHODS: A population-based sample of 1540 children ages 11-14 years in a large metropolitan area was studied. A questionnaire was used to determine presence and severity of back pain, availability of lockers, backpack use, use of 1 or 2 straps to carry backpack, activity limitations due to back pain, and use of pain medication for back pain. Gender, age, weight of the child, and weight of his or her backpack were recorded. Results of scoliosis screening were evaluated with regard to the above information. Data were analyzed using the chi test and univariate or multivariate logistic regression analysis as appropriate. RESULTS: Overall, 37% of the children reported back pain. Backpacks were used by 97% of children, hence there were too few students not using backpacks to treat backpack use as an independent variable. Multivariate analysis found back pain associated with use of a heavier backpack (P=0.001), younger age (P<0.001), female sex (P<0.001), and a positive screening examination for scoliosis (P=0.009). Children with lockers available reported less back pain (P=0.016). The use of 1 or 2 straps to carry the backpack did not have a significant association with back pain (P=0.588). Of the children who reported back pain, 34% limited their activity due to the pain, 14% use medication for pain relief, and 82% believed their backpack either caused or worsened their pain. CONCLUSIONS: The incidence of back pain in early adolescence approaches that seen in adults. Recommendations for an "acceptable" weight of backpacks cannot be made from this study, as the weights of students' backpacks seem directly proportional to the likelihood of back pain. This study identifies 2 factors associated with self-reported back pain in early adolescents that are amenable to change: availability of school lockers and lighter backpacks. These findings may be useful in advising families and influencing school policies.     

Idiopathic scoliosis in Korean schoolchildren: a prospective screening study of over 1 million children

Cross-sectional epidemiologic scoliosis screening was carried out to determine the current prevalence of scoliosis in the Korean population and to compare with the results of previous studies. Between 2000 and 2008, 1,134,890 schoolchildren underwent scoliosis screening. The children were divided into two age groups, 10–12-year-olds (elementary school) and 13–14-year-olds (middle school), to calculate age- and sex-specific prevalence rates. Children with a scoliometer reading ≥5° were referred for radiograms. Two surgeons independently measured curve types, magnitudes, and Risser scores (inter-observer r = 0.964, intra-observer r = 0.978). Yearly and overall prevalence rates of scoliosis were calculated. There were 584,554 boys and 550,336 girls in the sample, with a male to female ratio of 1.1:1. There were 77,910 (6.2%) children (26,824 boys and 51,086 girls) with scoliometer readings >5°, and 37,339 of them had positive results with Cobb angles ≥10° (positive predictive value, 46.4%). The overall scoliosis prevalence rate was 3.26%; girls had a higher prevalence (4.65%) than boys (1.97%). Prevalence rates increased progressively from 1.66 to 6.17% between 2000 and 2008, with the exception of 2002. According to age and gender, 10–12-year-old girls had the highest scoliosis prevalence rates (5.57%), followed by 13–14-year-old girls (3.90%), 10–12-year-old boys (2.37%), and 13–14-year-old boys (1.42%). In girls and boys, prevalence rates dropped by 64.53 and 60.65% among 10–12-year-olds and 13–14-year-olds, respectively (P = 0.00). The proportion of 10°–19° curves was 95.25 and 84.45% in boys and girls, respectively; and the proportion of 20°–29° curves was 3.91 and 11.28%, which was a significant difference (P = 0.00). Thoracic curves were the most common (47.59%) followed by thoracolumbar/lumbar (40.10%), double (9.09%), and double thoracic (3.22%) curves. A comparison of the curve patterns revealed significant differences between genders (P = 0.00). We present this report as a guide for studying the prevalence of idiopathic scoliosis in a large population, and the increasing trend in the prevalence of idiopathic scoliosis emphasizes the need for awareness.     

Low back pain in a cohort of 622 Tunisian schoolchildren and adolescents: an epidemiological study

Low back pain (LBP) in children was considered for many years to be a rare condition revealing a serious disease, but in the last two decades, epidemiological studies have shown that the prevalence of nonspecific LBP in children is high. This study was aimed at analyzing the prevalence, severity, consequences and associated factors of LBP in children. A cross-sectional study was undertaken in two preparatory schools in the city of Monastir, Tunisia, in April 2002. This study included a total of 622 children and adolescents—326 females and 296 males—with a mean age of 14 years (range: 11–19 years). They completed the questionnaire in the presence of the physician. For the first 201 questionnaires collected, the corresponding children and adolescents underwent a spine medical examination, with evaluation of pain by visual analog scale if LBP was present. A stepwise logistic regression analysis was carried out to determine the risk factors associated with LBP and chronic LBP. The cumulative lifetime prevalence of LBP was 28.4%. Eight percent of the subjects suffered from chronic LBP. LBP was responsible for 23% of school absenteeism and 29% for sports absenteeism. Medical care requirement was observed in 32.2% and psychological symptoms in 75%. Stepwise logistic regression analysis showed that three factors were associated with LBP: school failure (held back 1 year), odds ratio (OR) =2.6 (95% confidence interval [CI], 1.96–3.44), family history of LBP (parental or sibling LBP), OR=3.80 (95% CI, 2.94–5.92), dissatisfaction with school chair (in height and comfort), OR=3.40 (95% CI, 2.24–5.29). Two factors were associated with chronic LBP: dissatisfaction with school chair, OR=1.62 (95% CI, 1.46–3.32) and football playing, OR=3.07 (95% CI, 2.15–5.10). The prevalence of LBP among Tunisian schoolchildren and adolescents is high. This requires preventive measures and longitudinal studies, which are very important from the standpoint of public health.     

Prevalence of idiopathic scoliosis in anorexia nervosa patients: results from a cross-sectional study

Purpose

A long debate exists about the connection between anorexia nervosa (AN) and scoliosis due to conflicting evidence. No study so far has evaluated the prevalence of scoliosis in patients with AN. The aim of the study is to evaluate the prevalence of idiopathic scoliosis in patients with AN.

Methods

Design: cross-sectional study. Study group: convenience sample of all patients matching the inclusion criteria. Control group: female participants coming from an epidemiological screening for scoliosis. Inclusion criteria: patients had a diagnosis of AN during adolescence according to the DSM-IV-TR criteria. We applied a two-level screening using a Bunnell scoliometer and a radiograph. We calculated the odds ratio compared with participants coming from a school screening.

Results

Seventy-seven females with AN were compared to 816 females screened for scoliosis. The prevalence of scoliosis in the AN group was 16.9% (OR 5.77, 95% CI 3.12–10.67) with respect to the control group. If we consider as positive only those who received a scoliosis diagnosis during adolescence, the OR would be 3.15 (95% CI 1.55–6.42).

Discussion

This is the first study performed on patients with AN showing a sixfold greater odds of presenting with scoliosis. A cause–effect relationship cannot be determined due to the design.

     

New insights in the prevalence of scoliosis and musculoskeletal asymmetries in adolescents with esophageal atresia

BackgroundIncreased risk of scoliosis and musculoskeletal abnormalities in adolescents with esophageal atresia (EA) is reported, but the impact of these abnormalities on physical fitness and motor skills are not known.MethodsScoliosis was assessed radiographically and shoulder and chest abnormalities by a standardized protocol. Physical fitness was evaluated with Grippit, Six-minute walk test, and International Physical Activity Questionnaire and motor skills by Motor Assessment Battery for Children.ResultsSixty-seven EA adolescents median 16 (13–20) years participated. The prevalence of significant scoliosis (≥ 20º) was 12% (8/67) whereas 22% (15/67) had mild scoliosis (10–19º). Vertebral anomalies occurred in 18/67 (27%), eight of them (44%) had scoliosis. The majority of adolescents (15/23) with scoliosis did not have vertebral anomalies. Musculoskeletal abnormalities were detected in 22–78%. Balance problems occurred three times more frequently than expected (44% vs. 15%, p = 0.004). Submaximal exercise capacity was significantly reduced compared to reference values (p < 0.001). Scoliosis ≥ 20º was related to reduced physical activity (p = 0.008), and musculoskeletal abnormalities to reduced physical activity and impaired motor skills (p = 0.042 and p < 0.038, respectively).ConclusionsSignificant scoliosis was diagnosed in 12% of the EA adolescents and related to reduced physical activity. Musculoskeletal abnormalities identified in more than half of the patients, were related to reduced physical activity and impaired motor skills, and exercise capacity was significantly below reference group. EA patients with and without vertebral anomalies need health-promoting guidance to prevent impaired motor skills and consequences of reduced physical activity.Level of evidence: Prognostic Study, Level II     

Prevalence of low back pain in alpine ski instructors

STUDY DESIGN: Mailed survey to random sample of a specific population. OBJECTIVES: To examine the lifetime and point prevalence of low back pain among alpine ski instructors. BACKGROUND: The lifetime prevalence for back pain is up to 60% among some athletes. Published literature documents back pain among athletes participating in many sports. However, the prevalence of low back pain among alpine ski instructors has not been established. METHODS AND MEASURES: Surveys were mailed to 500 randomly selected members of the Professional Ski Instructors of America. The lifetime and point prevalence were determined by respondents' report regarding history of low back pain and current back pain. RESULTS: Two hundred four (75% of the 272 respondents) reported a history of low back pain. Eighty-five of those who responded (31%) reported current back pain. Over 9% of respondents missed 10 or more days of work because of back pain. CONCLUSIONS: The lifetime prevalence of back pain among respondents was similar to the general population. The respondents reported more lifetime prevalence of back pain than athletes of many other sports. The high prevalence of back pain among ski instructors may increase cost and decrease revenue for the employer. Prevention training in this population may decrease the prevalence of back pain and lessen costs to the employer and the alpine ski instructor.     

Ten-year follow-up evaluation of a school screening program for scoliosis. Is the forward-bending test an accurate diagnostic criterion for the screening of scoliosis?

STUDY DESIGN: A 10-year follow-up evaluation of the effectiveness of school screening for scoliosis performed in a closed island population. OBJECTIVES: To evaluate the diagnostic accuracy of methods used for screening scoliosis and to re-examine the long-term effectiveness of the school scoliosis screening program. SUMMARY OF BACKGROUND DATA: The diagnostic accuracy of the forward-bending test and the long-term efficacy of the screening programs have not been clearly established. METHODS: In 1987, 2700 pupils aged 8 to 16 years from the island of Samos were screened for scoliosis. The Adams forward-bending test, Moire topography, the scoliometer, and the humpometer were used. Radiologic evaluation of the spine was available for each pupil and the number of false-negative and false-positive results of the screening methods was calculated. Subsequently, sensitivity, specificity, and positive and negative predictive values were estimated for each screening technique. Pupils found positive for spinal deformity were then followed up regularly at yearly intervals. In 1997, all positive subjects attended a 10-year clinical and radiologic follow-up, and the remaining subjects were re-evaluated by a postal questionnaire and were clinically examined if necessary. RESULTS: Spinal deformity was found in 153 (5.66%) pupils. Scoliosis (defined as a spinal curvature > or = 10 degrees) was found in 32 pupils, for a prevalence of 1.18%. For scoliosis, the Adams forward-bending test showed a number of false-negative results (in five cases), for a sensitivity of 84.37% and specificity of 93.44%. The sensitivities of Moire topography, the humpometer, and the scoliometer were 100%, 93.75%, and 90.62%, respectively, and specificity was 85.38%, 78.11%, and 79.76% respectively. The negative predictive value of the forward-bending test was inferior to those of the other methods. During this scoliosis screening program, if cutoff limits for referral had been used, such as the asymmetry of two Moire fringes, a humpogram deformity of (D + H) = 10 mm, and 8 degrees of scoliometer angle, it would have been possible to reduce radiologic examination by 89.4%. Three (0.11%) pupils aged between 12 and 14 years with scoliotic deformities greater than 20 degrees underwent satisfactory nonoperative treatment with Boston braces. One pupil with a 40 degrees thoracic curvature, underwent satisfactory surgical treatment because of progression 1 year later. Of the 121 spinal deformities with an initial Cobb angle less than 10 degrees, 44 (35.8%), and of the 29 scoliotic deformities with an initial Cobb angle between 10 degrees and 20 degrees, 14 (48.3%) progressed (a Cobb angle difference of at least 5 degrees in more than one examination). Observation and physiotherapy were the only treatments applied to all except one of the pupils in these groups. CONCLUSIONS: The Adams forward-bending test cannot be considered a safe diagnostic criterion for the early detection of scoliosis (especially when it is used as the only screening tool) because it results in an unacceptable number of false-negative findings. For the early detection of scoliosis, a combination of back-shape analysis methods can be safely used with the introduction of cutoff limits for referral being a useful procedure. The incidence of significant scoliosis is low, and its natural history seems to be independent of early detection. The wide-spread use of school scoliosis screening with the use of the forward-bending test must be questioned.     

How back pain intensity relates to clinical and psychosocial factors in patients with idiopathic scoliosis

Objective

A pain intensity of 3 can reliably distinguish idiopathic scoliosis (IS) patients with acceptable pain or not. This research aims to analyze psychosocial, family and quality of life differences in patients according to their pain status.

Material and methods

Patients with IS, without previous surgery, Cobb ≥ 30° and age (12–40) were included in the study. They completed the questionnaires Numerical Rate Scale (NRS), Tampa Scale for Kinesiophobia (TSK)-11, SRS22r, Hospital Anxiety-Depression Scale (HADS), COMI item 7 (work/school absenteeism) and family APGAR. Comorbidities and family health history were collected. Analysis of covariance was performed to compare means between the PAIN (NRS > 3), (NRS <  = 3) groups controlling for the effect of age and the magnitude of the curve.

Results

In total, 272 patients were included. 37.1% belonged to the PAIN group (PG). The PG showed a significantly higher Cobb grade and age than the NO-PAIN group. After controlling for these variables, the PG had worse pain, mental health and SRS22-subtotal values. However, they did not differ in function or self-image. PG showed higher levels of kinesiophobia, anxiety, depression, absenteeism from work/school and impact on social/family environment. PG patients reported a higher prevalence of comorbidities and family history of nonspecific spinal pain.

Conclusions

Patients with IS and unacceptable pain constitute a group with a different incidence of psychological, social, family and comorbidities factors than those with acceptable pain. In contrast, the severity of IS was not substantially different between the groups. This profile is similar to that observed in patients with nonspecific spinal pain.

     

The association between cigarette smoking and back pain in adults.

STUDY DESIGN: A retrospective cohort study of adolescent idiopathic scoliosis. A comparison group of persons without scoliosis was also selected randomly from the general population. OBJECTIVES: To estimate the association between level of cigarette smoking and the prevalence and severity of back pain. METHODS: A postal questionnaire was used to elicit information on smoking histories, a variety of indices of low back pain, and potential confounding factors. The association between smoking and back pain was estimated separately for men and women in the cohort and in the comparison group using ordinal regression models. RESULTS: The questionnaire was completed by 1287 women and 184 men who had adolescent idiopathic scoliosis and by 1130 women and 621 men in the comparison population who did not have scoliosis. Statistically significant associations between back pain and current cigarette smoking were found in the two groups of women and men with scoliosis, but not among men selected from the general population. In the three former groups, proportional odds ratios comparing current smokers to persons who never smoked ranged from 1.4 to 1.9. Among current smokers, the prevalence of back pain increased with cigarette consumption, and the proportional odds ratios ranged from 1.2 to 1.8 per 10 pack-years (no. of cigarettes smoked per day x no. of years/20). In these three groups, intensity, frequency, and duration of episodes of back pain also were found to increase with smoking consumption. CONCLUSION: The finding that smokers have more frequent episodes of back pain may imply that smoking exacerbates back pain, and the observation that stronger associations between back pain and smoking were found in the scoliosis cohort suggests that smoking may have a greater impact on persons with damaged spines.     

Lower back pain in physically demanding college academic programs: a questionnaire based study

Background  

Lower back pain (LBP) is ranked first as a cause of disability and inability to work, and is expected to affect up to 90% of the worlds population at some point in their lifetime. The annual first time incidence of LBP is 5%, and the annual prevalence (i.e. those suffering at time of questioning) is between 15 and 63%. Prospective studies demonstrate that low back problems do not display a six-week spontaneous recovery pattern, as was once believed. The condition is regularly seen to worsen over time, becoming a chronic disorder, influenced by both physical and psychosocial factors.     

Prevalence and natural history of scoliosis and associated congenital vertebral anomalies in patients operated for esophageal atresia with or without tracheoesophageal fistula

BackgroundScoliosis has been reported after repair of esophageal atresia with or without tracheoesophageal fistula (EA-TEF). This study aims to investigate the prevalence and natural history of scoliosis and associated congenital vertebral anomalies in patients operated for EATEF.MethodsA retrospective review of patients operated for EA-TEF with radiological examination for the presence of scoliosis or associated spine congenital anomalies was done on 106 patients (ages 5–19 years).ResultsScoliosis was found in 53 patients (49%) for which 46 of these were in the thoracic region and 33 were right-thoracic curves. After a follow-up ranging from 5 to 14 years, four patients (3.7%) out of 106 were operated for scoliosis. Right-sided thoracotomy (RST) was the identifiable risk factor for scoliosis development; all patients with scoliosis had their EA repaired through RST. Congenital vertebral anomalies were found in 8 of those patients (7.5%). After a median follow-up of 6.5 years, no patients progressed enough to require operation.ConclusionScoliosis affects one of every two patients operated for EA; it may progress to the indication of surgery. RST was the identifiable risk factor for scoliosis development.     

Back pain reporting pattern in a Danish population-based sample of children and adolescents

STUDY DESIGN: A cross-sectional survey of 806 pupils in Odense, Denmark was performed. This survey included children and adolescents ages 8 to 10 and 14 to 16 years obtained through two-stage cluster sampling from schools stratified according to school type, location, and socioeconomic character of the uptake area. OBJECTIVES: To establish the 1-month prevalence of neck, middle back, and low back pain and the consequences this disorder may have in relation to age and gender. SUMMARY OF BACKGROUND DATA: The differences in definitions of back pain and the variety of age groups included in previous studies make it difficult to draw clear conclusions about the onset of pain for various spinal regions in the young. METHODS: Information on back pain within the preceding month, obtained through a standardized interview of 481 children and 325 adolescents, was categorized according to area of pain, age, and gender. The consequences of back pain also were studied. RESULTS: The 1-month prevalence of back pain was 39%. Thoracic pain is most common in childhood, whereas thoracic pain and lumbar pain are equally common in adolescence. Neck pain and pain in more than one area of the spine are rare in both age groups. No gender differences were found. Of those who had back pain, 38% also reported some type of consequence, usually either visits to a medical physician or diminished physical activities. CONCLUSIONS: For clinical and research purposes, neck pain, middle back pain, and low back pain in childhood should be regarded as three specific entities. In future research the data for different age groups should be reported separately.