AB0970 THE RELATION BETWEEN CONGENITAL STRUCTURAL MALFORMATIONS, DISC-VERTEBRA DEGENERATION AND DISC HERNIATION IN THE PEDIATRIC AGE GROUP
Authors: O. G. Illeez, F. E. Bahadir Ulger, I. Aktas
Journal: Annals of the Rheumatic Diseases (2020)

Background: Disc/vertebral degeneration and disc herniation are rare causes of low back pain in childhood. Their relationship with congenital anomalies were reviewed in few studies in literature (1-3). Objectives: To examine the relation between congenital structural malformations in the lumbar spine, early degeneration and lumbar disc herniation in pediatric age group patients with low back pain, and to determine the incidence of congenital structural malformations, disc/vertebral degeneration, and disc herniation. Methods: Four hundred patients with LBP persisting for at least six weeks were included in the study. Demographic characteristics, physical examination findings, and laboratory and imaging results were recorded for all patients. Severity of pain was determined using a visual analog scale (VAS). Lumbosacral X-rays were examined for the presence of lumbosacral transitional vertebrae (LSTV) and spina bifida occulta (SBO). The incidence of disc/vertebral degeneration and disc herniation was investigated at the L4-5 and L5-S1 level in lumbosacral magnetic resonans imaging of patients with and without congenital malformation (LSTV-SBO). Results: The study population consisted of 219 girls and 181 boys aged 10-17 years (mean age 14.9±1.9). Presentation symptoms were low back pain in 90.5% (n= 362), and low back-leg pain in 9.5% (n=38). The mean VAS score was 5.3±1.0. LSTV was determined in 67 (16.8%) patients and SBO in 62 (15.5%). Disc herniation was determined in 68 patients, at the L4-5 level in 26.5% (n=18), at the L5-S1 level in 48.5% (n=33), and at both levels in 25% (n=17). Vertebral degeneration was present at the L4-5 level in 14 (8.6%) patients and at the L5-S1 level in 39 (23.9%), while disc degeneration was present at the L4-5 level in 21 (12.8%) patients and at the L5-S1 level in 31 (19.0%). No significant difference was observed in the incidence of disc/vertebral degeneration and disc herniation in patients with congenital malformation. Disc herniation was significantly more common in patients with disc degeneration (p=0.003, p&lt;0.001). Congenital malformations were not observed in approximately 80% of patients without disc herniation and disc/vertebral degeneration. Conclusion: The presence of congenital malformations does not appear to represent a risk factor for early degeneration and disc herniation in pediatric age group. Congenital malformations, early degeneration, and disc herniation may constitute an underlying pathology in pediatric patients with persistent low back pain. References: [1]Milicić G, et al. 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. Coll Antropol. 2012. [2]Dang L, et al. Lumbar Disk Herniation in Children and Adolescents: The Significance of Configurations of the Lumbar Spine. Neurosurgery. 2015. [3]Zhang B, et al. Lumbosacral Transitional Vertebra: Possible Role inthe Pathogenesis of Adolescent Lumbar Disc Herniation. World Neurosurg. 2017. Disclosure of Interests: None declared