The role of intense athletic activity on structural lumbar abnormalities in adolescent patients with symptomatic low back pain

• Published in: European spine journal Vol. 25; no. 9; pp. 2842 - 2848
• Main Authors: Schroeder, Gregory D., LaBella, Cynthia R., Mendoza, Marco, Daley, Erika L., Savage, Jason W., Patel, Alpesh A., Hsu, Wellington K.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2016; Springer Nature B.V
• Subjects: Adolescent; Athletes; Child; Female; Humans; Intervertebral Disc Degeneration - diagnostic imaging; Intervertebral Disc Displacement - diagnostic imaging; Low Back Pain - etiology; Lumbar Vertebrae - diagnostic imaging; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Neurosurgery; Original Article; Prevalence; Retrospective Studies; Spondylolysis - diagnostic imaging; Surgical Orthopedics; Athletes; Pelvic incidence; Disc degeneration; Spondylolysis; Herniated disc
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-016-4647-5

Purpose To determine if adolescent athletics increases the risk of structural abnormalities in the lumbar spine. Methods A retrospective review of patients (ages 10–18) between 2004 and 2012 was performed. Pediatric patients with symptomatic low back pain, a lumbar spine MRI, and reported weekly athletic activity were included. Patients were stratified to an “athlete” and “non-athlete” group. Lumbar magnetic resonance and plain radiographic imaging was randomized, blinded, and evaluated by two authors for a Pfirrmann grade, herniated disc, and/or pars fracture. Results A total of 114 patients met the inclusion criteria and were stratified into 66 athletes and 48 non-athletes. Athletes were more likely to have abnormal findings compared to non-athletes (67 vs. 40 %, respectively, p  = 0.01). Specifically, the prevalence of a spondylolysis with or without a slip was higher in athletes vs. non-athletes (32 vs. 2 %, respectively, p  = 0.0003); however, there was no difference in the average Pfirrmann grade (1.19 vs. 1.14, p  = 0.41), percentage of patients with at least one degenerative disc (39 vs. 31 %, p  = 0.41), or disc herniation (27 vs. 33 %, p  = 0.43). Body mass index, smoking history, and pelvic incidence (51.5° vs. 48.7°, respectively, p  = 0.41) were similar between the groups. Conclusion Adolescents with low back pain have a higher-than-expected prevalence of structural pathology regardless of athletic activity. Independent of pelvic incidence, adolescent athletes with low back pain had a higher prevalence of spondylolysis compared to adolescent non-athletes with back pain, but there was no difference in associated disc degenerative changes or herniation.