Juvenile degenerative disc disease: a report of 76 cases identified by magnetic resonance imaging.
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.


OBJECTIVE
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.


METHODS
This is a retrospective review of patients less than 21 years old referred to a spine specialty practice with persistent low back pain.


METHODS
The charts of 1,877 patients less than 21 years old referred to a spine specialty practice for the evaluation of spinal problems.


METHODS
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.


CONCLUSIONS
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.
Dimar
John R
JR
Kenton D. Leatherman Spine Center, University of Louisville School of Medicine, Louisville, KY 40202, USA. lcarreon@spinemds.com
Glassman
Steven D
SD
Carreon
Leah Y
LY
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000000981:diagnostic imaging* / Q000473:pathology*; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D008161:Lumbosacral Region / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology*