Abstract
BACKGROUND CONTEXT
Low back pain (LBP) is common in children and adolescents, carrying substantial risk
for recurrence and continuation into adulthood. Studies have linked obesity to the
development of pediatric LBP; however, its association with lumbar spine degeneration,
alignment parameters, and opioid use remains debated.
PURPOSE
Considering the increasing prevalence of pediatric obesity and LBP and the inherent
issues with opioid use, this study aimed to assess the association of obesity with
lumbar spine degeneration, spinopelvic alignment, and opioid therapy among pediatric
patients.
STUDY DESIGN/SETTING
A retrospective study of pediatric patients presenting to a single institute with
LBP and no history of spine deformity, tumor, or infection was performed.
PATIENT SAMPLE
A totasl of 194 patients (mean age: 16.7±2.3 years, 45.3% male) were included, of
which 30 (15.5%) were obese.
OUTCOME MEASURES
Prevalence of imaging phenotypes and opioid use among obese to nonobese pediatric
LBP patients. Magnetic resonance and plain radiographic imaging were evaluated for
degenerative phenotypes (disc bulging, disc herniation, disc degeneration [DD], high-intensity
zones [HIZ], disc narrowing, Schmorl's nodes, endplate phenotypes, Modic changes,
spondylolisthesis, and osteophytes). Lumbopelvic parameters including lumbar lordosis,
pelvic tilt, sacral slope, pelvic incidence and pelvic incidence-lumbar lordosis (PI–LL)
mismatch were also examined.
METHODS
Demographic and clinical information was recorded, including use of opioids. The associations
between obesity and lumbar phenotypes or opiod use were assessed by multiple regression
models.
RESULTS
Based on multivariate analysis, obesity was significantly associated with the presence
of HIZ (adjusted OR: 5.36, 95% CI: 1.30 to 22.09). Further analysis demonstrated obesity
(adjusted OR: 3.92, 95% CI: 1.49 to 10.34) and disc herniation (OR: 4.10, 95% CI:
1.50 to 11.26) were associated with opioid use, independent of duration of symptoms,
other potential demographic determinants, and spinopelvic alignment.
CONCLUSIONS
In pediatric patients, obesity was found to be significantly associated with HIZs
of the lumbar spine, while disc herniation and obesity were associated with opioid
use. Spinopelvic alignment parameters did not mitigate any outcome. This study underscores
that pediatric obesity increases the risk of developing specific degenerative spine
changes and pain severity that may necessitate opioid use, emphasizing the importance
of maintaining healthy body weight in promoting lumbar spine health in the young.
Keywords
Abbreviation:
CI (confidence interval), DD (disc degeneration), HIZ (high-intensity zone), LBP (low back pain), LL (lumbar lordosis), OR (odds ratio), PI (pelvic incidence)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 21, 2023
Accepted:
March 15,
2023
Received in revised form:
February 7,
2023
Received:
October 30,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
FDA device/drug status: Not applicable.
Author disclosures: SSR: Nothing to disclose. ALH: Nothing to disclose. CK: Nothing to disclose. GMM: Nothing to disclose. KA: Nothing to disclose. PL: Nothing to disclose. JM: Nothing to disclose. AYLW: Nothing to disclose. ST: Nothing to disclose. TK: Nothing to disclose. JNB: Nothing to disclose. MC: Nothing to disclose. FMP: Nothing to disclose. HSA: Stock Ownership: Medyssey Inc, Bioventis Inc, Stryker, Spinalcyte Inc. Endowments: Mortan International (Paid directly to institution). DS: Royalties: Elsevier. Stock Ownership: Multiple, non medical related. Private investments; Board of Directors: Global Spine Journal, European Spine Journal. Scientific Advisory Board: Neurospinal innovations. Research Support -Investigator Salary: NIH, Rush University (Paid directly to institution). Grants: NIH (Paid directly to institution).
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