Causal connection of non-specific low back pain and disc degeneration in children with transitional vertebra and/or Spina bifida occulta: role of magnetic resonance--prospective study [Uzročna povezanost nespecifične niske križobolje i digeneracije diska kod djece s prijelaznim kralješkom i/ili spinom bifidom occultom - uloga magnetske rezonancije - prospektivna studija]

Miličić, Gordana and Krolo, Ivan and Antičević, Darko and Roić, Goran and Zadravec, Dijana and Bojić, Davor and Žutelija Fattorini, Matija and Bumči, Igor (2012) Causal connection of non-specific low back pain and disc degeneration in children with transitional vertebra and/or Spina bifida occulta: role of magnetic resonance--prospective study [Uzročna povezanost nespecifične niske križobolje i digeneracije diska kod djece s prijelaznim kralješkom i/ili spinom bifidom occultom - uloga magnetske rezonancije - prospektivna studija]. Collegium Antropologicum, 36 (2). pp. 627-633. ISSN 0350-6134

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Abstract

The problem of low back pain (LBP) in children is very common and many specialists are dealing with it in everyday practice. The cause for low back pain often is not found and classified under the diagnosis of non specific low back pain. The objective of this prospective study is to determine wether children with non specific low back pain and existence of anomalies in LS spine (transitional vertebra- TV and/or Spina bifida occulta SBO) also have the degeneration of the intervertebral disc (DD) L4-L5 and/or L5-S1. This prospective study included 69 patients from 8 to 16 years of age (X 12.81) of whom 40 were male (57.97%), and 29 female (42.03%). They all were examinated in University of Zagreb, "Sestre milosrdnice" University Hospital Center, Zagreb Children's Hospital, Department of Orthopaedic, Zagreb, Croatia. The reason of their visit was non specific low back pain. Pain was measured by visual analog scale (VAS) and mean score was three, duration of pain was between two and four weeks. Also, pain was sporadic, during daytime and not connected with level of physical activity. They all have undergone an algorithm of radiological examinations. Standard AP and LL radiographs (RTG) were made, as well as magnetic resonance (MR) of LS spine and sacrum in sagittal and transversal plane in T1 and T2 weighted sequence. The anomalies of L5 and S1 were found in 65 patients: transitional vertebra classified according to Castellvi et al. and SBO. In MRI in T2 weighted sequence DD was found in 61 patients which was classified modified from Pearce. Data analysis and comparison showed that 56patients with TV and/or SBO have changes on vertebral dynamic segment L5-S1 (VDS) and that means DD. In 13 patients only DD or spinal anomaly (TV and/or SBO) were found. Correlation between anomalies and DD in those patients was established by McNemar analysis and has shown significant difference (p=0.581) in favour of the patients with anomaly and DD. This has established that all of 56 patients with spinal anomaly could have DD as known cause of LBP.

Abstract in Croatian

Problem u smislu niske križobolje u djece i adolescenata bavi se sve više stručnjaka. Često se ne nađe uzrok niske križobolje i vode se pod dijagnozom nespecifične niske križobolje. Tema ove prospektivne studije je utvrditi, da djeca s nespecifičnom niskom križoboljom kojima se otkrije postojanje anomalija (prijelazni kralješak - PK i Spina bifida occulta – SBO) u lumbosakralnoj (L-S) kralješnici, imaju i degeneraciju intervertebralnog diska (DD) L4-L5 i/ili L5-S. Prospektivnom studijom obrađeno je 69 ispitanika od 8 do 16 godina (X 12,81) i to 40 (57,97%) muških i 29 (42,03%) ženskih ispitanika koji su pregledani u ortopedskoj ambulanti Klinike za dječje bolesti, KBC »Sestre milosrdnice«. Uzrok dolaska je bila nespecifična niska križobolja (NNK). Bol je mjerena vizualnom analognom skalom (VAS) i srednje vrijednosti su bile 3. Trajala je dva do četiri tjedna prije pregleda. Javljala se povremeno tijekom dana i nije bila uzročno povezana s fizičkom aktivnosti. Ispitanici su se podvrgli radiologijskom algoritmu pretraga. Učinjene su standardne snimke (RTG) L-S kralješnice u AP i LL projekciji i magnetska rezonancija (MR) L-S prijelaza i sakruma u sagitalnom i transverzalnom presjeku na T1 i T2 mjerenoj slici. Na RTG snimkama utvrđene su anomalije na L5 i S1 kralješku kod 65 ispitanika, i to PK koji se klasificirao prema Castellviju et al. i SBO. Na MR-u u T2 mjerenoj slici kod 61 ispitanika pronađen je DD koji se klasificirao modifikacijom prema Pearceu. Obradom i usporedbom podataka, kod 56 ispitanika je potvrđeno da imaju i promjenu na vertebralnom dinamičkom segmentu L5-S1 (VDS-u) (PK i/ili SBO) i DD. Kod 13 ispitanika su pronađeni ili samo DD ili samo anomalije (PK i/ili SBO). Korelacija između anomalija i DD-a kod ispitanika, analizirana je McNemarovim testom kojim je dobivena statistički značajna razlika (p=0,581) u korist onih ispitanika koji imaju i anomaliju i DD. Time je utvrđeno da je kod ispitanika, njih 56, uzrok DD-a anomalija u području L-S kralješnice, a time i uzrok njihove niske križobolje.

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