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León-Domínguez A, Cansino-Román R, Martínez-Salas JM, Farrington DM. Clinical examination and imaging resources in children and adolescent back pain. J Child Orthop 2023; 17:512-526. [PMID: 38050588 PMCID: PMC10693837 DOI: 10.1177/18632521231215860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/03/2023] [Indexed: 12/06/2023] Open
Abstract
Back pain is a relatively common complaint in children and adolescents. The pediatric patient presenting with back pain can often be challenging, and there are many well-known organic diagnoses that should not be missed. In younger children, an organic cause of back pain can often be found. However, back pain in older children and adolescents is often "non-specific." The differential diagnosis of back pain in children includes neoplasms, developmental, and inflammatory conditions. Basic steps should include an in-depth anamnesis, a systematic physical examination, and standard spine radiographs (anteroposterior and lateral). Nevertheless, advanced diagnostic imaging and laboratory studies should be included when indicated to avoid missing or delaying a serious diagnosis. If other types of imaging tests are necessary (magnetic resonance imaging, computed tomography, bone scan, or single photon emission computed tomography), they should be guided by diagnostic suspicion.
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2
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Neves AB, Martins R, Matela N, Atalaia T. PosturAll: A Posture Assessment Software for Children. Bioengineering (Basel) 2023; 10:1171. [PMID: 37892901 PMCID: PMC10603916 DOI: 10.3390/bioengineering10101171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/21/2023] [Accepted: 10/03/2023] [Indexed: 10/29/2023] Open
Abstract
From an early age, people are exposed to risk factors that can lead to musculoskeletal disorders like low back pain, neck pain and scoliosis. Medical screenings at an early age might minimize their incidence. The study intends to improve a software that processes images of patients, using specific anatomical sites to obtain risk indicators for possible musculoskeletal problems. This project was divided into four phases. First, markers and body metrics were selected for the postural assessment. Second, the software's capacity to detect the markers and run optimization tests was evaluated. Third, data were acquired from a population to validate the results using clinical software. Fourth, the classifiers' performance with the acquired data was analyzed. Green markers with diameters of 20 mm were used to optimize the software. The postural assessment using different types of cameras was conducted via the blob detection method. In the optimization tests, the angle parameters were the most influenced parameters. The data acquired showed that the postural analysis results were statistically equivalent. For the classifiers, the study population had 16 subjects with no evidence of postural problems, 25 with mild evidence and 16 with moderate-to-severe evidence. In general, using a binary classification with the train/test split validation method provided better results.
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Affiliation(s)
- Ana Beatriz Neves
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências, Universidade de Lisboa, 1749-016 Lisboa, Portugal;
| | - Rodrigo Martins
- Escola Superior De Saúde Da Cruz Vermelha Portuguesa, 1300-125 Lisboa, Portugal; (R.M.); (T.A.)
| | - Nuno Matela
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências, Universidade de Lisboa, 1749-016 Lisboa, Portugal;
| | - Tiago Atalaia
- Escola Superior De Saúde Da Cruz Vermelha Portuguesa, 1300-125 Lisboa, Portugal; (R.M.); (T.A.)
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3
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Compagnone D, Cecchinato R, Pezzi A, Langella F, Damilano M, Redaelli A, Vanni D, Lamartina C, Berjano P, Boriani S. Diagnostic Approach and Differences between Spinal Infections and Tumors. Diagnostics (Basel) 2023; 13:2737. [PMID: 37685273 PMCID: PMC10487270 DOI: 10.3390/diagnostics13172737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/08/2023] [Accepted: 08/19/2023] [Indexed: 09/10/2023] Open
Abstract
STUDY DESIGN A systematic review of the literature about differential diagnosis between spine infection and bone tumors of the spine. BACKGROUND AND PURPOSE The differential diagnosis between spine infection and bone tumors of the spine can be misled by the prevalence of one of the conditions over the other in different areas of the world. A review of the existing literature on suggestive or even pathognomonic imaging aspects of both can be very useful for correctly orientating the diagnosis and deciding the most appropriate area for biopsy. The purpose of our study is to identify which imaging technique is the most reliable to suggest the diagnosis between spine infection and spine bone tumor. METHODS A primary search on Medline through PubMed distribution was made. We identified five main groups: tuberculous, atypical spinal tuberculosis, pyogenic spondylitis, and neoplastic (primitive and metastatic). For each group, we evaluated the commonest localization, characteristics at CT, CT perfusion, MRI, MRI with Gadolinium, MRI diffusion (DWI) and, in the end, the main features for each group. RESULTS A total of 602 studies were identified through the database search and a screening by titles and abstracts was performed. After applying inclusion and exclusion criteria, 34 articles were excluded and a total of 22 full-text articles were assessed for eligibility. For each article, the role of CT-scan, CT-perfusion, MRI, MRI with Gadolinium and MRI diffusion (DWI) in distinguishing the most reliable features to suggest the diagnosis of spine infection versus bone tumor/metastasis was collected. CONCLUSION Definitive differential diagnosis between infection and tumor requires biopsy and culture. The sensitivity and specificity of percutaneous biopsy are 72% and 94%, respectively. Imaging studies can be added to address the diagnosis, but a multidisciplinary discussion with radiologists and nuclear medicine specialists is mandatory.
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Affiliation(s)
| | | | - Andrea Pezzi
- IRCCS Ospedale Galeazzi—Sant’Ambrogio, 20157 Milan, Italy
- Residency Program in Orthopaedics and Traumatology, University of Milan, 20141 Milan, Italy
| | | | - Marco Damilano
- IRCCS Ospedale Galeazzi—Sant’Ambrogio, 20157 Milan, Italy
| | | | - Daniele Vanni
- IRCCS Ospedale Galeazzi—Sant’Ambrogio, 20157 Milan, Italy
| | | | - Pedro Berjano
- IRCCS Ospedale Galeazzi—Sant’Ambrogio, 20157 Milan, Italy
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4
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Fiaschi Ramos AC, Ferreira Silva RM, Bizinotto T, Teixeira de Rezende LM, Miñana-Signes V, Monfort-Pañego M, Noll PRES, Noll M. Tools for Assessing Knowledge of Back Health in Adolescents: A Systematic Review Protocol. Healthcare (Basel) 2022; 10:healthcare10081591. [PMID: 36011248 PMCID: PMC9408774 DOI: 10.3390/healthcare10081591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/21/2022] Open
Abstract
Back pain is common in adolescents as a result of their typical daily activities. There is a critical need for developing instruments that can assess the adolescents’ knowledge of proper posture, because adequate postural habits are essential for preventing back pain and facilitating physical well-being. Unfortunately, there is insufficient understanding about appropriate back health in the general public, even though this knowledge is decisive in the development of physical skills and attainment of health literacy. Furthermore, relevant substantive literature is scarce. Therefore, the proposed systematic review aims to identify instruments that are used for assessing knowledge of back health in adolescents. Relevant search terms and descriptors will be combined, and searches will be carried out in a uniform sequence within the PubMed, Embase, CINAHL, and Cochrane Library databases. Eligible articles must present data on the assessment of the adolescents’ knowledge of back health and describe the applied instrumentation. Articles will be selected by two reviewers independently; all disagreements will be resolved by a third reviewer. Mendeley and the Rayyan software will be used for the systematic review, and the checklist proposed by Brink and Louw will be used to verify the methodological quality of the included studies. Our findings may confirm the relevance of constructing and validating back health instruments for use in Brazil and other countries.
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Affiliation(s)
| | | | | | | | | | | | - Priscilla Rayanne e Silva Noll
- Campus Ceres, Federal Institute Goiano, Morrinhos 74605-050, Brazil
- Campus São Paulo, University of São Paulo, São Paulo 01246-904, Brazil
| | - Matias Noll
- Campus Goiânia, Federal University of Goiás, Goiânia 74690-631, Brazil
- Campus Ceres, Federal Institute Goiano, Morrinhos 74605-050, Brazil
- Correspondence: (A.C.F.R.); (M.N.)
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5
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Surgical correction of Scheuermann’s kyphosis by posterior-only approach: a prospective study. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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6
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Krasin E, Schermann H, Snir N, Tudor A, Behrbalk E. A Quick and Comprehensive Guide to Differential Diagnosis of Neck and Back Pain: a Narrative Review. SN COMPREHENSIVE CLINICAL MEDICINE 2022; 4:232. [PMID: 36320816 PMCID: PMC9610337 DOI: 10.1007/s42399-022-01321-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 11/05/2022]
Abstract
The list of diagnostic options when approaching a patient with axial pain is impressively complex. Many offer limited diagnostic workups, but we could not find a truly comprehensive diagnostic guide to assist in the diagnostic evaluation. In this short paper, we briefly described a long list of medical conditions, each of which can manifest as back or neck pain, and whose prevalence ranges from common to very rare. We then proposed an algorithm for classifying them into subgroups. Further referral to diagnostic tests and specialist consultations, after assignment to one of those subgroups, could save time and unnecessary tests. We believe that this review and the proposed diagnostic algorithm can be valuable for medical education and for use in the primary care setting for the diagnostic evaluation of any type of back or neck pain in all patient groups.
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Affiliation(s)
- Elisha Krasin
- Division of Orthopedic Surgery at Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haggai Schermann
- Division of Orthopedic Surgery at Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nimrod Snir
- Division of Orthopedic Surgery at Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adrian Tudor
- Division of Orthopedic Surgery at Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Behrbalk
- Department of Orthopedic Surgery at Hillel Yaffe Medical Center, Hadera, Israel, affiliated with the Rappaport Faculty of Medicine, Technion, Haifa, Israel
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7
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Noll M, Kjaer P, Mendonça CR, Wedderkopp N. Motor performance and back pain in children and adolescents: A systematic review. Eur J Pain 2021; 26:77-102. [PMID: 34365693 DOI: 10.1002/ejp.1850] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 08/06/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Motor performance during childhood and adolescence is recognized as a relevant determinant of present and future health, but its effects on back pain (BP) remain unclear. In this systematic review, we aimed to identify the association between motor performance and BP in children and adolescents. DATABASES AND DATA TREATMENT A literature search was performed in the MEDLINE, Scopus, Embase, SPORTDiscus and CINAHL databases. We included cross-sectional, cohort, case-control and controlled clinical trials (data from control groups). The inclusion criteria were as follows: (a) participants aged 6-19 years; (b) assessment motor performance components; (c) assessment of BP and (d) reported measures of association. The risk of bias was assessed by the Downs and Black instrument and the quality of evidence by the grading of recommendations, assessment, development and evaluation (GRADE). RESULTS A total of 2360 articles were identified, 25 of which were included in our systematic review. Of the 25 studies, 19 were evaluated as having a low risk of bias. GRADE indicated that 20 studies presented low or very low quality. Most of the studies evaluated flexibility (n = 16), muscle endurance (n = 18) and muscle strength (n = 9). Aerobic capacity, balance and speed were also examined in some studies (n < 5). Overall, motor performance (flexibility, muscle endurance, muscle strength, aerobic capacity, balance and speed) was not associated with BP. Most of the results were inconsistent because of the lack of studies, risk of bias and low quality of evidence. Only trunk extensor muscle endurance was associated with decreased BP with moderate quality of the supporting evidence. Prospective studies with a low risk of bias are warranted to further clarify this relationship in childhood and adolescence and findings may support more targeted and effective health promotion interventions. SIGNIFICANCE This systematic review shows that motor performance (flexibility, muscle endurance, muscle strength, aerobic capacity, balance and speed) was not associated with BP in children and adolescents. Most of the results were inconsistent because of the lack of studies, risk of bias and low quality of evidence. Only trunk extensor muscle endurance was associated with decreased BP with moderate quality of supporting evidence.
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Affiliation(s)
- Matias Noll
- Instituto Federal Goiano, Ceres, Brazil.,Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiânia, Brazil.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Per Kjaer
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Health Sciences Research Centre, UCL University College, Odense, Denmark
| | | | - Niels Wedderkopp
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Sports Medicine Clinic, Orthopedic Department, Hospital of Lillebaelt, Odense, Denmark
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8
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Abstract
Back pain has long been considered an uncommon complaint in the pediatric population. When present, teaching had been that pediatric back pain almost always has a diagnosable cause, many of which are progressive and potentially debilitating. Recent evidence has suggested that pediatric back pain is not only more common than once thought but also, within certain populations, benign and idiopathic. This, in turn, places an increasing amount of pressure on pediatricians to accurately assess and manage their patients presenting with complaints of back pain. The aim of this article is to serve as a review of the current literature on pediatric back pain. The article reviews the epidemiology, basic anatomy, and important elements of a history and examination, which should be considered when a child presents complaining of back pain. Last, a common differential diagnosis with evaluation and management is also given to help guide pediatricians through their medical decision making.
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Affiliation(s)
- Micah Lamb
- Children's Hospital of Philadelphia, Philadelphia, PA
| | - Joel S Brenner
- Children's Specialty Group PLLC, Norfolk, VA.,Children's Hospital of The King's Daughters, Norfolk, VA.,Eastern Virginia Medical School, Norfolk, VA
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9
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Noll M, Wedderkopp N, Mendonça CR, Kjaer P. Motor performance and back pain in children and adolescents: a systematic review and meta-analysis protocol. Syst Rev 2020; 9:212. [PMID: 32928303 PMCID: PMC7491087 DOI: 10.1186/s13643-020-01468-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/26/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The relationship between motor performance and back pain in children and adolescents remains unclear. This article describes the protocol for a systematic review to summarize the knowledge about the association between motor performance, such as agility, flexibility, balance, strength, muscle endurance, and cardiorespiratory fitness, and back pain. Thus, our aim is to identify the influence of motor performance on back pain among children and adolescents. METHODS Two independent researchers will search MEDLINE, Scopus, Embase, SPORTDiscus, and CINAHL databases, with no period or language restrictions. We will include cross-sectional, cohort, case-control, and controlled clinical trial studies based on the following criteria: (a) participants from 6 to 19 years of age, (b) assessment of motor performance, (c) assessment of back pain, and (d) report measures of associations between motor performance and back pain. Study quality and risk of bias will be assessed using an adapted version of the Downs and Black instrument. Grading of Recommendations, Assessment, Development, and Evaluations will be used to assess the strength of the body of evidence. Meta-analyses of association measures will be performed for each type of motor performance, separately for different study types. The results will be reported using forest to show the pooled effect of findings and funnel plots to assess precision of the data. If studies are not homogeneous, results from the meta-analyses will not be reported. Associations will then be synthesized descriptively using a pragmatic approach. DISCUSSION This systematic review will provide critical insights into the association between motor performance and back pain among children and adolescents; this information may help support clinical practice guidelines as well as public health programs. ETHICS AND DISSEMINATION Protocol was written according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020178496.
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Affiliation(s)
- Matias Noll
- Instituto Federal Goiano, Ceres, Brazil. .,Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiânia, Brazil. .,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense, Denmark.
| | - Niels Wedderkopp
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense, Denmark. .,Sports Medicine Clinic, Orthopedic Department, Hospital of Lillebaelt, Odense, Denmark.
| | | | - Per Kjaer
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense, Denmark. .,Health Sciences Research Centre, UCL University College, Odense, Denmark.
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10
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Cruz E, Simian A, Chahin A. DOLOR LUMBAR EN NIÑOS. REVISTA MÉDICA CLÍNICA LAS CONDES 2020. [DOI: 10.1016/j.rmclc.2020.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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11
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Beck A, Skaggs DL, Kovach T, Kiehna E, Andras LM. Two cases of paralysis secondary to aneurysmal bone cysts with complete neurologic recovery. Spine Deform 2020; 8:339-344. [PMID: 32048217 DOI: 10.1007/s43390-019-00023-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 08/25/2019] [Indexed: 11/27/2022]
Abstract
DESIGN Case report (retrospective). OBJECTIVE These two cases of paralysis secondary to aneurysmal bone cysts (ABCs) demonstrated complete neurologic recovery following decompression and posterior spinal fusion. Although neurologic injury from ABCs has been described, information about the prognosis in the pediatric population is limited. METHODS We review two cases of paralysis caused by ABCs in the thoracic spine in pediatric patients. RESULTS Two patients (aged 12 and 13 years) presented to our emergency department with inability to ambulate and 0/5 strength in their lower extremities due to spinal cord compression from ABCs in their thoracic spine. Both patients had been unable to ambulate (case 1: nonambulatory for 2 weeks before presentation; case 2: nonambulatory for 1 week before presentation). The second patient also had loss of bowel and bladder control. They were managed with decompression and posterior spinal fusion. Both patients made complete neurologic recoveries. CONCLUSIONS It is unclear whether age, chronicity of compression, or other factors contributed; nevertheless, the recovery in these two similar patients far exceeded initial expectations, especially in the case that presented as an American Spinal Injury Association Impairment Scale class A. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Aaron Beck
- Harbor UCLA Medical Center, Torrance, CA, 90502, USA
| | - David L Skaggs
- Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA, 90027, USA.
| | - Tracy Kovach
- Harbor UCLA Medical Center, Torrance, CA, 90502, USA
| | - Erin Kiehna
- Pediatric Neurosurgery, Hemby Children's Hospital, Novant Health, Charlotte, USA
| | - Lindsay M Andras
- Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA, 90027, USA
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12
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The impact of spine sarcoma on mental health and well-being. Spine J 2019; 19:1603-1605. [PMID: 31125690 DOI: 10.1016/j.spinee.2019.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 05/10/2019] [Accepted: 05/13/2019] [Indexed: 02/03/2023]
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13
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Noll M, Candotti CT, da Rosa BN, Vieira A, Loss JF. Back pain and its risk factors in Brazilian adolescents: a longitudinal study. Br J Pain 2019; 15:16-25. [PMID: 33633850 DOI: 10.1177/2049463719871751] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Owing to the lack of longitudinal studies in Latin American countries, we aimed to evaluate back pain and its risk factors in a 3-year longitudinal study of Brazilian adolescents. We analysed data of 525 adolescents (aged 11-16 years) attending primary school (fifth to eighth grade) in Brazil. The students were administered the self-reported Back Pain and Body Posture Evaluation Instrument (BackPEI) questionnaire in 2011 and at a follow-up evaluation that was conducted 3 years later (2014). Back pain was the outcome variable; the exposure variables included exercise, behavioural, hereditary and postural factors. Generalized estimating equations were used to perform a Poisson regression model with robust variance to evaluate the risk factors for back pain. The prevalence of back pain at baseline was 56% (n = 294); this increased significantly at the 3-year follow-up evaluation to 65.9% (n = 346). The frequency of experiencing back pain also significantly increased after 3 years in both boys (p = 0.002) and girls (p = 0.001). The prevalence of back pain increased significantly in adolescents up to the age of 13 years, stabilized in those aged 14 years and older and was higher among girls. A family history of back pain (in the parents), watching television for lengthy periods and carrying a backpack asymmetrically were predictors for back pain.
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Affiliation(s)
| | | | | | - Adriane Vieira
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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14
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Hebert JJ, Leboeuf-Yde C, Franz C, Lardon A, Hestbæk L, Manson N, Wedderkopp N. Pubertal development and growth are prospectively associated with spinal pain in young people (CHAMPS study-DK). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1565-1571. [PMID: 30740638 DOI: 10.1007/s00586-019-05905-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 01/26/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE To examine the prospective associations of pubertal development and linear growth with spinal pain frequency and duration in children. METHODS We recruited students from 10 public primary schools. Over 42 months, pubertal development was assessed four times and categorized according to Tanner stages 1-5, and height was measured on seven occasions. Occurrences of spinal pain were reported weekly via text messaging. We constructed variables for spinal pain duration (total weeks with pain) and frequency (number of episodes). Potential associations between pubertal development and growth were examined with generalized estimating equations and reported with incident rate ratios (IRRs). All models were adjusted for potential confounders. RESULTS Data from 1021 children (53% female; mean [SD] age = 9.4 [1.4] years), with median participation duration of 39 months, were included. Advancing pubertal development was associated with increased spinal pain duration (IRR [95% CI] = 1.90 [1.45, 2.49] to 5.78 [4.03, 8.29]) and frequency of pain episodes (IRR [95% CI] = 1.32 [1.07, 1.65] to 2.99 [2.24, 3.98]). Similar associations were observed for each 1-cm change in height in 6 months with spinal pain duration (IRR [95% CI] = 1.19 [1.15, 1.23]) and frequency (IRR [95% CI] = 1.14 [1.11, 1.17]). The relations between pubertal development and spinal pain, as well as growth and spinal pain, were largely independent. CONCLUSIONS In young people, pubertal development and linear growth are likely to be independent risk factors for the development of spinal pain. Pubertal development demonstrates evidence of dose-response in its relationship with spinal pain. This knowledge may assist healthcare providers with clinical decision-making when caring for pediatric patients. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Jeffrey J Hebert
- Faculty of Kinesiology, University of New Brunswick, Fredericton, NB, E3B 5A3, Canada. .,School of Psychology and Exercise Science, Murdoch University, Murdoch, Australia.
| | - Charlotte Leboeuf-Yde
- Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Claudia Franz
- Private Practice, Haderslev, Denmark.,Danish Agency for Patient Complaints, Aarhus, Denmark
| | - Arnaud Lardon
- Institut Franco-Européen de Chiropraxie, Ivry sur Seine, France.,CIAMS, Université Paris-Sud, Université Paris-Saclay, 91405, Orsay Cedex, France.,CIAMS, Université d'Orléans, 45067, Orléans, France
| | - Lise Hestbæk
- Danish Agency for Patient Complaints, Aarhus, Denmark.,Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Neil Manson
- Canada East Spine Centre, Saint John, NB, Canada.,Department of Orthopaedic Surgery, Saint John Regional Hospital, Saint John, NB, Canada.,Department of Orthopaedic Surgery, Dalhousie University, Halifax, NS, Canada
| | - Niels Wedderkopp
- Faculty of Kinesiology, University of New Brunswick, Fredericton, NB, E3B 5A3, Canada.,Orthopedic Department, Hospital of Southwestern Jutland, Esbjerg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
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15
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Nielsen E, Andras LM, Skaggs DL. Diagnosis of Spondylolysis and Spondylolisthesis Is Delayed Six Months After Seeing Nonorthopedic Providers. Spine Deform 2019; 6:263-266. [PMID: 29735135 DOI: 10.1016/j.jspd.2017.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 10/07/2017] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN Retrospective single center. OBJECTIVE Our purpose was to quantify the time to diagnosis of spondylolysis/spondylolisthesis in symptomatic patients after first seeking medical care. SUMMARY OF BACKGROUND DATA Several studies have found a high prevalence of pars defects in adolescent athletes with back pain, up to 47%. A review by the Scoliosis Research Society Evidence-Based Medicine Committee reports that both nonsurgical and surgical treatment of symptomatic spondylolysis effectively relieves pain and allows most patients to return to activities. Nonoperative treatment outcomes improve with early diagnosis. METHODS A retrospective chart review was conducted of patients presenting at our institution between 2005 and 2015 with symptomatic spondylolysis or spondylolisthesis with radiographic confirmation. Medical records were reviewed for demographics, date of symptom onset, date of initial presentation to a health care provider, type of provider, and date of diagnosis. RESULTS Forty-six patients met the inclusion criteria. Average patient age was 14 years (range: 6-19 years). Forty-one percent (19/46) of patients had spondylolysis, and 59% (27/46) of patients had spondylolisthesis. Of those with spondylolisthesis, 20 had grade I, 4 had grade II, 2 had grade III, and 1 had grade IV slips. The average time between onset of symptoms and initial presentation was 24 weeks (orthopedic: 21 weeks, nonorthopedic: 29 weeks, unknown: 18 weeks; p = .26). The average delay between initial presentation to a health care provider and diagnosis was 15 weeks. Time from initial presentation to diagnosis was 1 week for orthopedic surgeons, 25 weeks for nonorthopedic providers, and 10 weeks for unknown providers; this difference was significant (p = .02). CONCLUSION Diagnosis of spondylolysis/spondylolisthesis was significantly longer after seeing a nonorthopedic versus an orthopedic provider. Education of primary care providers on this topic is warranted. Children suffering from back pain from spondylolysis/spondylolisthesis may benefit from early referral to an orthopedic surgeon. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Ena Nielsen
- Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
| | - Lindsay M Andras
- Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
| | - David L Skaggs
- Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA.
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16
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Yurube T, Kakutani K, Okamoto K, Manabe M, Maeno K, Yoshikawa M, Sha N, Kuroda R, Nishida K. Lumbar spondylolysis: A report of four cases from two generations of a family. J Orthop Surg (Hong Kong) 2018; 25:2309499017713917. [PMID: 28617180 DOI: 10.1177/2309499017713917] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Spondylolysis is a major cause of back pain in children and adolescents. The prevalence of spondylolysis depends on the sex, race, and congenital abnormality. These biases suggest hereditary predisposition as an etiology of spondylolysis. However, no conclusive evidence still exists regarding the inheritance for spondylolysis. Herein, we report rare cases with familial occurrence of lumbar spondylolysis. In two generations of a Japanese family, three brothers including identical twins complained of back pain related to sports activities. Clinical, radiographic, and computed tomographic examinations identified spondylolysis at L4 and L5 in all these boys. The father experienced long-term back pain and had spondylolisthesis at L4-L5 and healed spondylolysis at L5. The daughter and mother did not show any lumbar spondylolysis. The frequent development of spondylolysis at L4, a rarely affected segment, in four of six family members (66.7%) support that lumbar spondylolysis has an underlying genetic etiology, primarily autosomal dominant inheritance.
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Affiliation(s)
- Takashi Yurube
- 1 Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kenichiro Kakutani
- 1 Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koji Okamoto
- 2 Department of Orthopaedic Surgery, Kobe Century Memorial Hospital, Kobe, Japan
| | - Michihiko Manabe
- 2 Department of Orthopaedic Surgery, Kobe Century Memorial Hospital, Kobe, Japan
| | - Koichiro Maeno
- 1 Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masaho Yoshikawa
- 2 Department of Orthopaedic Surgery, Kobe Century Memorial Hospital, Kobe, Japan
| | - Norihide Sha
- 2 Department of Orthopaedic Surgery, Kobe Century Memorial Hospital, Kobe, Japan
| | - Ryosuke Kuroda
- 1 Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kotaro Nishida
- 1 Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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17
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Carberry AR, Hanson K, Flannery A, Fischer M, Gehlbach J, Diamond C, Wald ER. Diagnostic Error in Pediatric Cancer. Clin Pediatr (Phila) 2018; 57:11-18. [PMID: 28478722 DOI: 10.1177/0009922816687325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to ( a) determine the frequency of diagnostic errors in pediatric cancer, ( b) categorize errors, and ( c) underscore themes associated with misdiagnosis. This is a retrospective cohort study at a tertiary children's hospital of 265 patients with new oncologic diagnoses. The diagnostic error rate was 28%. Compared with those with no diagnostic error, those in whom there was an error were more likely to have ( a) more visits before diagnosis ( P < .001), ( b) not been seen in an acute care setting ( P = .03), ( c) inappropriate treatment ( P < .001), and ( d) misinterpreted laboratory studies or imaging ( P < .001). Themes in diagnostic errors were lack of appropriate evaluation for persistent symptoms (47%), failure to recognize signs and symptoms suggestive of malignancy (45%), and misinterpretation of tests (8%). Clinicians should consider diagnostic evaluation for multiple visits for the same complaint or a constellation of signs and symptoms suggestive of malignancy.
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Affiliation(s)
| | - Keith Hanson
- 2 University of Illinois College of Medicine at Peoria, Peoria, IL, USA
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18
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Gardner K, Kharasch S, Raja A, Balza R, Bhatia K, Miller ES. Back Pain in a Healthy Teenager. J Emerg Med 2017; 53:907-911. [PMID: 28684061 DOI: 10.1016/j.jemermed.2017.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 04/25/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Kelly Gardner
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Sigmund Kharasch
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Ali Raja
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Rene Balza
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Department of Radiology, Harvard Medical School, Boston, Massachusetts
| | - Kriti Bhatia
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Emily S Miller
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
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19
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Hanke LF, Tuakli-Wosornu YA, Harrison JR, Moley PJ. The Relationship Between Sacral Slope and Symptomatic Isthmic Spondylolysis in a Cohort of High School Athletes: A Retrospective Analysis. PM R 2017; 10:501-506. [PMID: 28993288 DOI: 10.1016/j.pmrj.2017.09.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 09/26/2017] [Accepted: 09/29/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Spondylolysis with and without anterolisthesis is the most common cause of structural back pain in children and adolescents, but few predictive factors have been confirmed. An association between abnormal sacropelvic orientation and both spondylolysis and spondylolisthesis has been supported in the literature. Sacral slope and other sacropelvic measurements are easily accessible variables that could aid clinicians in assessing active adolescents with low back pain, particularly when the diagnosis of spondylolysis is suspected. OBJECTIVE To examine the relationship between sacral slope and symptomatic spondylolysis in a cohort of active adolescents. DESIGN Case-control retrospective study. SETTING Academic outpatient physiatry practice. PATIENTS Seventy-four patients of primarily adolescent age (between 12 and 22 years old) with a chief complaint of low back pain and presence of lateral radiographs of the lumbar spine were enrolled. Cases (n = 37) were defined as subjects with evidence of spondylolysis on both radiograph and magnetic resonance imaging of the lumbar spine. Controls (n = 37) were defined as subjects without spondylolysis. METHODS Using a single sagittal radiograph, taken with the patient standing, a fellowship-trained interventional spine physiatrist measured the sacral slope of each subject (angle between the superior plate of S1 and a horizontal reference on sagittal imaging of the lumbosacral spine). Ages and genders were collected from medical records. MAIN OUTCOME MEASUREMENTS The primary outcome was mean sacral slope. Mean sacral slope of cases was compared with mean sacral slope of controls with the Student t-test. RESULTS Ages ranged from 12 to 22 for both groups, with no significant differences in age between the groups (cases: 16.8 ± 2.3 years; controls: 17.7 ± 2.7 years). The patients with spondylolysis (cases) consisted of 29 male and 8 female patients, whereas those without spondylolysis (controls) consisted of 15 male and 21 female patients (gender details for 1 patient were not available). The mean sacral slope among cases was 42.4°, whereas the mean sacral slope among controls was 37.4°. The difference achieved significance (P = .014). CONCLUSIONS The interdependence of positional parameters, such as sacral slope, with anatomic parameters, such as pelvic incidence, can affect lumbar lordosis and therefore upright positioning and loading of the spine. Sacral slope may be an important variable for clinicians to consider when caring for young athletes with low back pain, particularly when the index of suspicion for spondylolysis is high. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Leigh F Hanke
- Department of Physiatry, Hospital for Special Surgery, New York, NY.,Department of Physiatry, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
| | - Yetsa A Tuakli-Wosornu
- Department of Physiatry, Hospital for Special Surgery, New York, NY.,Department of Physiatry, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
| | - Julian R Harrison
- Department of Physiatry, Hospital for Special Surgery, New York, NY.,Department of Physiatry, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
| | - Peter J Moley
- Department of Physiatry, Hospital for Special Surgery, New York, NY.,Department of Physiatry, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
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