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MRI Shows Back Trouble May Begin Before Puberty

Degenerative disc disease-a precursor to low back pain-is a common condition affecting adults and often attributed to numerous confounding factors, particularly aging, obesity, lack of activity or proper conditioning, or disease.  The hallmark of degenerative disc disease is lower back pain, one of the most common clinical complaints in adults.  Long considered to be a consequence of aging, a recent study presented at the Radiological Society of North America (RSNA) annual meeting in Dec. 2003 has found that disc degeneration may actually have its beginnings at a fairly young age:  in children!

This study evaluated magnetic resonance imaging (MRI) exams of the spines of 154 children in northeastern Scotland.  Surprising, investigators found that 14 children (9 percent) had abnormalities in at least one of their intervertebral discs - the backbone's "shock absorber." MRI was performed on the 10-year-olds as part of a larger study exploring causes of spinal stenosis, or a narrowing of the spinal canal.

Intervertebral discs are round, spongy pads of cartilage that sit between the vertebrae, cushioning the backbone as the body moves. With normal aging, the elastic core of the disc solidifies, contributing to a gradual loss of flexibility in the back. Fissures and cracks within the discs may also occur, allowing the gel-filled interior to bulge and extend into the spinal canal, occasionally irritating the nerve root.

The 14 degenerated discs found by researchers in this study showed signs of early bulging or tearing. All were located in the lower, or lumbar, region of the spine. None of the children in the study - 79 girls, 75 boys - had ever reported lower back or leg pain. Disc degeneration may alter the mechanical architecture of the back, predisposing to muscle and ligament sprains and strains, as well as arthritis of the spinal joints. This indicates that disc degeneration is not necessarily associated with back pain, and may begin in early childhood.

Lower back problems affect millions of adults. In the United Kingdom, 3 million workdays were lost in 2002 due to lower back pain, according to the National Health Service. In the United States, back pain is the second most common cause of lost work, following the common cold, according to the American Academy of Physical Medicine and Rehabilitation. Americans spend at least $50 billion each year on lower back pain, according to the National Institute of Neurological Disorders and Stroke.

Proper back care should include learning about correct posture and how to stretch the back, as well as being physically active on a regular basis. Researchers plan to conduct a follow-up study on these same children in 10 years to help determine whether early disc abnormalities worsen or stay the same as an individual ages

Created: 1/15/2004  -  Donnica Moore, M.D.

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