The role of intense athletic activity on structural lumbar abnormalities in adolescent patients with symptomatic low back pain.
To determine if adolescent athletics increases the risk of structural abnormalities in the lumbar spine.



A retrospective review of patients (ages 10-18) between 2004 and 2012 was performed. Pediatric patients with symptomatic low back pain, a lumbar spine MRI, and reported weekly athletic activity were included. Patients were stratified to an "athlete" and "non-athlete" group. Lumbar magnetic resonance and plain radiographic imaging was randomized, blinded, and evaluated by two authors for a Pfirrmann grade, herniated disc, and/or pars fracture.



A total of 114 patients met the inclusion criteria and were stratified into 66 athletes and 48 non-athletes. Athletes were more likely to have abnormal findings compared to non-athletes (67 vs. 40 %, respectively, p = 0.01). Specifically, the prevalence of a spondylolysis with or without a slip was higher in athletes vs. non-athletes (32 vs. 2 %, respectively, p = 0.0003); however, there was no difference in the average Pfirrmann grade (1.19 vs. 1.14, p = 0.41), percentage of patients with at least one degenerative disc (39 vs. 31 %, p = 0.41), or disc herniation (27 vs. 33 %, p = 0.43). Body mass index, smoking history, and pelvic incidence (51.5° vs. 48.7°, respectively, p = 0.41) were similar between the groups.



Adolescents with low back pain have a higher-than-expected prevalence of structural pathology regardless of athletic activity. Independent of pelvic incidence, adolescent athletes with low back pain had a higher prevalence of spondylolysis compared to adolescent non-athletes with back pain, but there was no difference in associated disc degenerative changes or herniation.
Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, 925 Chestnut St., Philadelphia, PA, USA. gregdschroeder@gmail.com.
Gregory D
GD
Schroeder
Northwestern University Feinberg School of Medicine, Chicago, USA.|Department of Pediatric Orthopaedic Surgery and Sports Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, USA.
Cynthia R
CR
LaBella
Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair, Suite 1350, Chicago, IL, 60611, USA.
Marco
M
Mendoza
Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair, Suite 1350, Chicago, IL, 60611, USA.
Erika L
EL
Daley
Department of Orthopaedic Surgery, The Cleveland Clinic, Cleveland, OH, USA.
Jason W
JW
Savage
Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair, Suite 1350, Chicago, IL, 60611, USA.
Alpesh A
AA
Patel
Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair, Suite 1350, Chicago, IL, 60611, USA.
Wellington K
WK
Hsu
D000293:Adolescent; D056352:Athletes; D002648:Child; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000000981:diagnostic imaging*; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging*; D017116:Low Back Pain / Q000209:etiology*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D013169:Spondylolysis / Q000000981:diagnostic imaging*
Athletes; Disc degeneration; Herniated disc; Pelvic incidence; Spondylolysis