Elsevier

Clinical Radiology

Volume 58, Issue 12, December 2003, Pages 985-989
Clinical Radiology

A Comparative Roentgenographic Analysis of the Lumbar Spine in Male Army Recruits with and without Lower Back Pain

https://doi.org/10.1016/S0009-9260(03)00296-4Get rights and content

Abstract

AIM: To determine whether there is an association between lumbar spine radiographic findings and reported current and/or past lower back pain (LBP).

MATERIALS AND METHODS: Four hundred and sixty-four age-matched (mean age 18 years±2 months) consecutive male army recruits were examined. Half of them had a history of episodes of LBP. An orthopaedic evaluation (including radiographs of the lumbar spine) is part of the routine medical examination for all military recruits. Two senior orthopaedic surgeons and one radiologist who performed the morphological measurements assessed the radiographs.

RESULTS: We found an increased frequency of right-sided scoliosis, lumbar lordosis, sacral lumbarization, wedge vertebra, bilateral spondylolysis of L5 and/or a sagittal diameter of less than 12 mm among the recruits with LBP. No such association was found with spina bifida, left-sided scoliosis, hemi-lumbarization, sacralization and hemi-sacralization, Schmorl's nodules or mild degenerative changes.

CONCLUSION: Given that radiographic screening shows that LBP is more common in those with spinal deformity it may be a reasonable means of predicting which individuals are more likely to develop LBP.

Introduction

Radiographs of the lumbar spine may be obtained in patients with lower back pain (LBP) in order to provide information on the presence of any pathology or an anatomical irregularity (e.g. congenital deformity, postural abnormality, degenerative change, tumours, inflammation or changes in the structure of the bone). A correlation between the radiographic findings and LBP is to be expected in some conditions, for example tumours and vertebral osteomyelitis, but their value in predicting future episodes of back pain in other pathologies is a matter of controversy. Some authors reported an association between lumbar spine abnormalities such as spina bifida [1], lumbarization of S1 [2], spondylolysis and spondylolisthesis 3, 4 and LBP, while others failed to find such a link 5, 6, 7. Our search of the literature yielded no report of an investigation on a large age-matched homogenous population.

In the current study, we sought to determine the frequency of lumbar abnormalities and the dimensions of the spinal canal in a homogenous and allegedly healthy population of young men (military recruits) in search of any correlation between a history of prior and current LBP and lumbar spine abnormalities.

Section snippets

Subjects and Methods

The study cohort included 464, 18-year-old (mean±S.D. 18 years±2 months) male army recruits who volunteered to participate. They all had joined the Israel Defense Forces (IDF) during a 2-month period. According to the IDF policy at the time, all recruits joining special combat units underwent radiographs of their lumbar spine (the authors emphasize that they did not necessarily agree with this protocol). They were assured that their replies to the questions on their histories of back problems

Results

Sixty-nine (29.7%) of the 232 patients with LBP had lumbar scoliosis compared with 41 (17.7%) of the 232 patients without LBP (p<0.0022). The difference in the occurrence of lumbar scoliosis between the two groups was mainly found for right-sided scoliosis (16.8% in the LBP group compared with 5.6% in the control group, p<0.0001), while the occurrence of left lumbar scoliosis was the same in both groups (Table 1). All of the curves were minor and did not exceed 20°.

No significant difference was

Discussion

We examined the occurrence of lumbar spine abnormalities and LBP in a homogenous population of 18-year-old military recruits. They were divided into two groups, one with and one without LBP, and the results of their vertebral spine assessment were evaluated and compared. There was a significantly higher incidence of abnormalities in the LBP group. Taking the radiographs in the supine position underestimates the degree of spondylolisthesis but not the extent of its presence. The radiographs were

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