Spinal Abnormalities Typical of Aging Seen in Obese Teens

CHICAGO — Obese adolescents appear to be at risk for spinal disease that is not typically seen until adulthood.

A review of low back MRIs on 228 adolescents, aged 12-20 years, revealed that lumbar spine abnormalities are most common in children with a high body mass index (BMI) and back pain, Dr. Judah G. Burns reported at the annual meeting of the Radiological Society of North America.

Among the 188 patients with back pain who met the inclusion criteria, MRI abnormalities were observed in 52% (97 patients). Disc disease was identified in 91 of the 97 patients, including multi-level disease in 40%.

When BMI was calculated for the 108 teens with weight data, lumbar spine abnormalities were observed in 28 of 44 (64%) with a BMI greater than the 85th percentile for age, as compared with 28 of 64 (44%) at or below healthy weights.

The finding of more disc disease in obese teens might be intuitive, given what is known in the adult population, but this is the first study to document the association, said Dr. Burns, a fellow in diagnostic neuroradiology at The Children's Hospital at Montefiore in New York City.

The Centers for Disease Control and Prevention reports that 18% of Americans aged 12-19 are overweight.

The abnormalities observed in the study are typically associated with degenerative disease of the spine, which occurs with aging and is not usually seen until people are in their 30s, 40s, or 50s, co-author Dr. Michael Lipton, medical director of MRI services at Montefiore, said at a press conference.

“We basically have evidence of something that is accelerating the aging process dramatically in these children,” he said. “They're decades ahead of their time.”

The investigators excluded from the study patients with trauma and scoliosis, as well as those with genetic, metabolic, and developmental conditions associated with predisposition to spinal abnormalities.

With these findings in otherwise healthy teens with back pain, “we have another link in the chain of the end-organ damage that can result from obesity. From a public health perspective, I think that's significant,” Dr. Burns said at the press briefing.

Press briefing moderator Dr. Deborah Levine, a professor at Harvard Medical School, Boston, said the findings are worrisome and emphasize the need to stem the rising tide of pediatric obesity in America.

Dr. Levine did, however, question whether the study criteria might have over-represented children with severe back pain, since MRI is not typically performed for this indication in children.

Dr. Burns responded that the reasons prompting patients to go to the ER and receive an MRI were not entirely clear, but that severity of pain might have been the case for many of the MRIs.

The study also included 40 adolescents without back pain, and 8 (20%) of these patients had an abnormal MRI. Among these 8 patients, abnormal MRIs were observed in 6 adolescents with a BMI greater than the 85th percentile and in 2 with a BMI less than the 85th percentile, a difference that was not statistically significant, Dr. Burns said.

The findings do not support routine use of MRI in children with back pain, he added.

A prospective study is needed in children with obesity, not necessarily with back pain, to determine the longitudinal effects of obesity and whether lumbar disease is as common in adolescents as it is in adults.

He noted that back pain accounted for just 0.4% of pediatric ED visits in one study (Clin. Pediatr. 1999;38:401-6).

Disclosures: The investigators disclosed no relevant conflicts of interest.