Primary prevention of disc degeneration related symptoms

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Elvin Hines
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1 Primary prevention of disc degeneration related symptoms Aron Lazary SPINE SCIENCES STATE OF THE ART FORUM September 13/14, 2013, Geneva

2 Why the prevention? Popular saying: Prevention is better than cure Hippocrates: prevention to disease was the primary focus of healthcare New molecular findings Genomics Diagnostic technologies Computational tools 4P MEDICINE Personalized Predictive Preventive Participatory Individual diagnosis and treatment strategies How, when and in whom a disease will develop Actions before the disease occurs Proactive individuals and communities

healthcare New molecular findings Genomics Diagnostic technologies Computational tools 4P MEDICINE

3 Levels of prevention PRIMARY SECONDARY TERTIARY Before the person gets the disease aims risk assessment inhibit or postpone the development of health disease education and promotion reduces programs both the incidence and prevalence lifestyle and of environmental a disease changes immunization After the disease has occurred to screening find and programs treat disease in early stage reduces risk reduction its impact on the individual or society medical interventions Symptomatic disease to prevent damage and pain from the disease development of new treatments reduces rehabilitation complications and disability

the disease has occurred to screening find and programs treat disease in early stage reduces risk reduction its impact on the individual or society

4 Levels of prevention PRIMARY Don t smoke! campaign SECONDARY Lung cancer screening (X-ray CT) TERTIARY Quality of life after lung surgery

General population Workers School age Detailed literature review Synthesis of evidence Recommendations Very limited data on primary prevention Effect of risk factor modification (?

5 General population Workers School age Detailed literature review Synthesis of evidence Recommendations Very limited data on primary prevention Effect of risk factor modification (?) - multidimensionality Limited evidence on different secondary and tertiary prevention Level A: physical activity/exercise and biopsychosocial education Participation of individuals and society as well as more research (RCT)

) - multidimensionality Limited evidence on different secondary and tertiary prevention Level A:

6 Problems with prevention Medicine vs public health Doctors, life scientists vs politicians, economists, clerks Research, prevention programs, marketing Funding Under-researched topic (underpowered studies) Google Pubmed low back pain + prevention low back pain + surgery What should be prevented? Pathology vs symptomatic disease

Under-researched topic (underpowered studies) Google Pubmed low back pain + prevention 3

7 Spinal symptoms and disc degeneration LBP IDD Ito K and Creemers L, GSJ 2013

8 Spinal symptoms and disc degeneration LBP IDD N=558 Age=21y

9 Primary prevention when? N= 439

10 Prevalence of disc degeneration related symptoms in children Literature review ( , 29 papers) 19 countries, children (age: 6-18y) Self-reported low back pain (ever) Self-reported low back pain (last year) 70% 60% y = x R² = , p< % 60% y = 0.063x R² = , p< % 50% 40% 40% 30% 30% 20% 20% 10% 10% 0% Age 0% Age : spinal pain was reported

000 children (age: 6-18y) Self-reported low back pain (ever) Self-reported low back pain (last year) 70% 60% y

11 Primary prevention when? N = 771

12 Symptomatic childhood predicts symptomatic adulthood Groups (1994) LBP in 1994 (%) 12-15y old y old y old male 32 5 female 38 7 LBP>30 days in 1994 (%) Days with LBP in 1994 LBP in 2002* (Odds Ratio) > *adjusted for age and gender LBP>30 days in 2002* (Odds Ratio)

1994 (%) Days with LBP in 1994 LBP in 2002* (Odds Ratio) 0 1.00 1.00 1-7 1.60 1.

13 Risk factors for back pain associated with school Literature review ( , 27 papers) 19 countries, children (age: 9-18y) Nonmodifiable risk factors Age Female gender Previous back pain episode Positive family history Disc degeneration Modifiable risk factors Sitting habits Smoking Overweight Backpack Sport Psychosocial factors Posture Disc degeneration

000 children (age: 9-18y) Nonmodifiable risk factors Age Female gender Previous back pain

14 Physical activity and LBP N=9,413 Isometric back muscle endurance Sport activity: NS

15 N=439

16 N=7542

17 N=546

18 N=26,766 (61.4%)

19 Posture Role of sagittal and frontal alignment

20 Poor posture as a risk factor for back pain N = 766 Age = 14y Posture types* Neutral Hyperlordotic Flat Sway Sacral slope Lumbar lordosis Thoracic kyphosis Frequency* 30.2% 21.8% 22.5% 25.6% Back pain* (Odds Ratio)

slope Lumbar lordosis Thoracic kyphosis Frequency* 30.

21 Primary prevention programs Bio-psycho-social model Functional capacity Enviroment Behavior and psyho

22 Primary prevention programs N=398

23 N=497, Age=8y Comic Book of the Back Lasting effect on knowledge

24 Registered RCT (NCT ) Level A Young soldiers Primary prevention program Ex: LBP limited work/activity, >48h, seek health care Department of Defense (US)

29 Discussion 4P in spine care > PREVENTION Low evidence in literature Lack of comprehensive, multinational studies Lack of evidence based prevention programme Interdisciplinary cooperation needed public health spine specialists researchers + teachers!

30 Thank you!

LOW BACK PAIN; MECHANICAL

1 ORTHO 16 LOW BACK PAIN; MECHANICAL Background This case definition was developed by the Armed Forces Health Surveillance Center (AFHSC) for the purpose of epidemiological surveillance of a condition