| Juvenile degenerative disc disease: a report of 76 cases identified by magnetic resonance imaging. | |
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MedLine Citation:
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PMID: 17482117 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Persistent low back pain in the young remains a significant diagnostic and treatment challenge for clinicians. Traditionally, chronic low back pain in this population has been attributed to either serious undetected pathology or psychosocial etiologies. This assumption may be incorrect because patients in this population may have underlying juvenile degenerative disc disease (JDDD), an important pathological diagnosis in the adult population. PURPOSE: The purpose of this study is to report the presentation, radiographic findings, diagnosis, and treatment modalities of juvenile patients presenting with persistent low back pain for greater then 6 months. STUDY DESIGN: This is a retrospective review of patients less than 21 years old referred to a spine specialty practice with persistent low back pain. PATIENT SAMPLE: The charts of 1,877 patients less than 21 years old referred to a spine specialty practice for the evaluation of spinal problems. OUTCOME MEASURES: Magnetic resonance images (MRI) were obtained and reviewed by a neuroradiologist and two orthopedic surgeons. METHODS: Patients younger than 21 years old with persistent low back pain for greater that 6 months were identified. Patients with scoliosis, Scheuermann's kyphosis, spondylolisthesis, fracture, tumor, and metabolic bone disease were excluded. Standard demographic information, relevant medical history and physical examination findings were collected. Patients were evaluated with an MRI of their spines to detect any potential underlying pathology. The success of various treatment modalities used was reviewed. The findings of this study were correlated to those of the available literature following a thorough review. RESULTS: Seventy-six patients (34 males, 42 females) with degenerative disc disease were identified on MRI. The mean age was 17.1 years (range 11.5-21.0) with a mean body mass index (BMI) of 24.5 (range 17.7-35.4). Thirty-one had associated radiculopathy. There was 11 smokers, 20 involved in athletics, 17 with co-morbidities, and 9 with a BMI greater than 30. A distinct subgroup of 13 patients with multilevel concurrent spinal stenosis was documented. Four of this subgroup required surgical intervention for severe radicular or claudication symptoms. The majority of JDDD patients were successfully treated with nonoperative modalities. CONCLUSION: The findings of this study question whether lumbosacral degenerative disc disease, commonly thought to exist only in an older population, in fact begins earlier in selected patients. Our study confirms the findings of others that there is a definite population of juveniles that present with chronic low back pain who have degenerative disc disease identified on MRI. Within this population is a subgroup of patients with concurrent congenital spinal stenosis. Most patients with JDDD appear to be well managed by traditional nonoperative treatment modalities. |
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Authors:
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John R Dimar; Steven D Glassman; Leah Y Carreon |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2007-01-24 |
Journal Detail:
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Title: The spine journal : official journal of the North American Spine Society Volume: 7 ISSN: 1529-9430 ISO Abbreviation: Spine J Publication Date: 2007 May-Jun |
Date Detail:
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Created Date: 2007-05-07 Completed Date: 2007-07-12 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101130732 Medline TA: Spine J Country: United States |
Other Details:
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Languages: eng Pagination: 332-7 Citation Subset: IM |
Affiliation:
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Kenton D. Leatherman Spine Center, University of Louisville School of Medicine, Louisville, KY 40202, USA. lcarreon@spinemds.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Child Female Humans Intervertebral Disk / pathology*, radiography* Low Back Pain / etiology, pathology, radiography Lumbosacral Region / pathology, radiography Magnetic Resonance Imaging Male Retrospective Studies Spinal Diseases / complications, pathology*, radiography* |
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