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A Population-Based Study of Juvenile Disc Degeneration and Its Association with Overweight and Obesity, Low Back Pain, and Diminished Functional Status
Dino Samartzis, DSc1; Jaro Karppinen, MD, PhD2; Florence Mok, MSc1; Daniel Y.T. Fong, PhD3; Keith D.K. Luk, MCh(Orth), FRCSE, FRCSG, FRACS, FHKAM(Orth)1; Kenneth M.C. Cheung, MBBS, MD, FRCS, FHKCOS, FHKAM(Orth)1
1 Department of Orthopaedics and Traumatology, University of Hong Kong, Queen Mary Hospital, Professorial Block, Fifth Floor, 102 Pokfulam Road, Pokfulam, Hong Kong, SAR, China. E-mail address for D. Samartzis: dsamartzis@msn.com. E-mail address for K.M.C. Cheung: ken-cheung@hku.hk
2 Department of Physical and Rehabilitation Medicine, Institute of Clinical Sciences, University of Oulu, Box 5000, 90014 Oulu, Finland
3 School of Nursing, University of Hong Kong, William M.W. Mong Block, Li Ka Shing Faculty of Medicine Building, Third Floor, 21 Sassoon Road, Pokfulam, Hong Kong, SAR, China
View Disclosures and Other Information
Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the Area of Excellence Programme of Hong Kong. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at the Department of Orthopaedics and Traumatology, University of Hong Kong, Hong Kong, SAR, China
A commentary by Michael J. Bolesta, MD, is available at www.jbjs.org/commentary and is linked to the online version of this article.

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Apr 06;93(7):662-670. doi: 10.2106/JBJS.I.01568
A commentary by Michael J. Bolesta, MD, is available here
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Little is known regarding juvenile disc degeneration in individuals with normal spinal alignment. Consequently, the purpose of this study was to assess the prevalence, determinants, and clinical relevance associated with juvenile disc degeneration of the lumbar spine in individuals without spinal deformities.


A cross-sectional assessment of disc degeneration in juveniles was performed as part of a population-based study of 1989 Southern Chinese volunteers. Adolescents and young adults from thirteen to twenty years of age were defined as "juveniles." Juvenile subjects with no spinal deformity (n = 83) were stratified into two groups, those with and those without juvenile disc degeneration. Sagittal T2-weighted magnetic resonance images (MRI) were evaluated for the presence and extent of disc degeneration as well as other spinal findings. Demographics were assessed and clinical profiles were collected with use of standardized questionnaires.


Juvenile disc degeneration was present in 35% (twenty-nine) of the juveniles without spinal deformity. Disc bulging or extrusion (p < 0.001), high-intensity zones on MRI (p = 0.040), and greater weight (p < 0.001) and height (p = 0.002) were significantly more prevalent in subjects with juvenile disc degeneration. Adjusted multivariate logistic regression modeling demonstrated that Asian-modified body-mass index (BMI) values in the overweight or obese range had a significant association with juvenile disc degeneration (odds ratio = 14.19; 95% confidence interval = 1.44 to 140.40; p = 0.023). Overweight and obese individuals had greater severity of disc degeneration than underweight and normal-weight individuals (p = 0.036). Furthermore, individuals with juvenile disc degeneration had an increased prevalence of low back pain and/or sciatica (p = 0.002), greater low back pain intensity (p < 0.001), diminished social functioning (p = 0.049), and greater physical disability (p < 0.05) than individuals without disc degeneration. The p value of <0.05 for physical disability represents both the physical function (p = 0.006) and the physical component (p = 0.032) of the SF-36.


This study demonstrated that the presence of juvenile disc degeneration was strongly associated with overweight and obesity, low back pain, increased low back pain intensity, and diminished physical and social functioning. Furthermore, an elevated BMI was significantly associated with increased severity of disc degeneration. This study has public health implications regarding overweight and obesity and the development of lumbar disc disease.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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