Nonspecific low back pain during childhood: a retrospective epidemiological study of risk factors.
OBJECTIVE
In contrast to what was believed in the past, nonspecific low back pain is a fairly frequent condition in children, whose pathophysiology remains unclear as yet. Although many factors have been implicated in its development, results are often contradictory.


METHODS
Our study aims to examine most of the reasons investigated in the international literature, as well as the previously unexamined impact of passive smoking in its clinical appearance. It is a retrospective study that investigates the symptom of nonspecific low back pain during a 12-month period before the visit of children to our department. The research included 692 children aged 7.5 to 14 years. The data were collected using a semi-structured questionnaire, which included a mix of open and closed questions, followed by physical examination during their visit.


RESULTS
A total of 153 children were considered to present nonspecific low back pain during the previous year. The determinant factors appear to be greater age, the male sex, larger height, increased weight, dissatisfaction with school chairs, the clinical presentation of back pain in at least 1 parent, and coexisting anatomic orthopedic conditions. On the contrary, the weight of the school bag, the way in which it was carried and participation in sports, as well as the time spent by children in front of the TV or PC playing video or play station games, did not appear to have a statistically significant correlation with its appearance. In general, passive smoking does not appear to be a risk factor (P[r] = 0.341), and does not seem to play a leading role in the etiology of the condition. Furthermore, even the heaviness of parental smoking (over 20 cigarettes a day) does not seem to alter the appearance of the disease. The effect of nonspecific low back pain in children's activities was measured using Hannover Functional Ability and Rolland Morris questionnaires, appropriately modified to childhood, where he found a moderate or severe restriction of activity in 23.52% (score >5) and 19.61% (score >6), respectively.


CONCLUSIONS
The data analysis shows that nonspecific low back pain in children is a benign disorder with an unknown pathophysiological mechanism. Many anthropometric characteristics and environmental factors are implicated, but to a different degree each time. Passive smoking as well as the heaviness thereof does not appeal to play in important role in its clinical presentation. Further investigation is deemed necessary to determine the existence of other risk factors, as well as the level of their participation in the condition's pathophysiology.
Kaspiris
Angelos
A
Department of Trauma and Orthopaedics, Thriasio General Hospital-NHS, Attica, Greece. angkaspiris@upatras.gr
Grivas
Theodoros B
TB
Zafiropoulou
Crisi
C
Vasiliadis
Elias
E
Tsadira
Olia
O
D000293:Adolescent; D000367:Age Factors; D001827:Body Height; D002648:Child; D005260:Female; D006115:Greece / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D017116:Low Back Pain / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D050177:Overweight; D015995:Prevalence; D012189:Retrospective Studies; D012737:Sex Factors