MRI Shows Back Trouble May Begin Before Puberty

"We found degenerative changes in the spine much earlier than we ever would have suspected," said lead author Francis W. Smith, M.D., consultant radiologist and sports medicine physician at Woodend Hospital in Aberdeen, Scotland. "This study revises our thoughts on when we should begin preventive back care. Proactive steps should begin early in life, even before puberty."

Dr. Smith presented the findings today at the 89th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA).

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 Dr. Smith and colleagues 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 suffered from 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 points out that disc degeneration is not necessarily associated with back pain, and may begin in early childhood.

"There is no history of poor nutrition, obesity or other known disease in these children," Dr. Smith said. "We suspect there may be genetic causes, although unrecognized trauma in sports or at play could also be a cause."

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, according to Dr. Smith, should include learning about correct posture and how to stretch the back, as well as being physically active. Dr. Smith and his fellow 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.

Co-authors of the study are Janet E. Jeffrey, M.Sc., and Richard W. Porter, M.D.

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RSNA is an association of more than 35,000 radiologists, radiation oncologists and related scientists committed to promoting excellence in radiology through education and by fostering research, with the ultimate goal of improving patient care. The Society is based in Oak Brook, Ill.