Low Back Pain in Adolescent Athletes: Comparison of Diagnoses Made by General Orthopedic Surgeons and Spine Surgeons

Abstract

Background: Nonspecific low back pain (NSLBP) is a term used to describe low back pain of unknown origin with no identifiable generators. Over a decade ago, it was reported to account for about 85% of all cases of low back pain, although there is some doubt about the frequency. The purpose of this study was to determine the frequency of NSLBP in adolescent athletes diagnosed by general orthopedic surgeons and by spine surgeons.

Materials and methods: A total of 69 adolescent athletes consulted our sports spine clinic to seek a second opinion for low back pain. Data on age, sex, type of sport played, the previous diagnosis made by general orthopedic surgeons, and the final diagnosis made by spine surgeons were collected retrospectively from medical records.

Results: The frequency of NSLBP diagnosed by general orthopedic surgeons was 18.9% and decreased to 1.4% after careful imaging and functional nerve block examination by spine surgeons. The final diagnoses made by spine surgeons for those patients previously diagnosed as having NSLBP by general orthopedic surgeons were as follows: early-stage lumbar spondylolysis, discogenic low back pain, facet joint arthritis, lumbar disc herniation, and lumbar apophyseal ring fracture.

Conclusions: In adolescent athletes, the rate of NSLBP diagnosed by general orthopedic surgeons decreased markedly when the diagnosis was made by spine surgeons. A thorough medical interview, careful physical examination, appropriate diagnostic imaging, and selective nerve block examination can effectively identify the cause of low back pain.

Keywords: adolescence; athlete; diagnosis; low back pain; nonspecific low back pain.

Figure 1

Types of sports played by adolescents with low back pain.

Figure 2

Diagnoses of low back pain made by general orthopedic surgeons. Abbreviations: LBP, low back pain; LDH, lumbar disc herniation.

Figure 3

Diagnoses of low back pain made by a spine surgeon. Abbreviations: LBP, low back pain; LDH, lumbar disc herniation.

Figure 4

Final diagnoses by a spine surgeon for 13 patients in whom symptoms were classified as NSLBP by general orthopedic surgeons. Abbreviation: LBP, low back pain; LDH, lumbar disc herniation; NSLBP, nonspecific low back pain.

Figure 5

T1- and T2-weighted magnetic resonance imaging (MRI) and short tau inversion recovery (STIR)-MRI for case 1 (a 13-year-old with early-stage lumbar spondylolysis). The STIR-MRI showed the high signal change (arrow) at the left pedicle of L5 more clearly than the T1- and T2-weighted images. Left: T1-weighted image (T1WI). Middle: T2-weighted image (T2WI). Right: STIR.

Figure 6

Magnetic resonance imaging (MRI) T2-weighted image (T2WI) and STIR-MRI for case 2 (an 18-year-old with disc-related low back pain). Only STIR-MRI revealed a HIZ (arrow) at the posterior annulus fibrosus at L5-S1. Abbreviations: HIZ, high signal intensity zone; STIR, short tau inversion recovery.

Figure 7

Magnetic resonance imaging (MRI) T2-weighted image (T2WI) and CT scan for case 3 (a 15-year-old with facet joint arthritis). Although there were not obvious abnormal findings on MRI, CT clearly showed osteoarthritis of left facet joint (arrow) at the level of L5-S1. Left: MRI T2-weighted image. Right: CT. Abbreviations: CT, computed tomography.

Figure 8

Magnetic resonance imaging (MRI) T2-weighted image and CT scan for case 4 (a 12-year-old with a lumbar apophyseal ring fracture). T2-weighted MRI showed only slight central bulging of the L5-S1 disc, whereas CT revealed an apophyseal ring fracture (arrow) at the level of the caudal L5 endplate. Abbreviations: CT, computed tomography.