Primary prevention of disc degeneration related symptoms Aron Lazary SPINE SCIENCES STATE OF THE ART FORUM September 13/14, 2013, Geneva
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
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
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 (?) - 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)
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 3 660 000 1 651 low back pain + surgery 4 830 000 4 939 What should be prevented? Pathology vs symptomatic disease
Spinal symptoms and disc degeneration LBP IDD Ito K and Creemers L, GSJ 2013
Spinal symptoms and disc degeneration LBP IDD N=558 Age=21y
Primary prevention when? N= 439
Prevalence of disc degeneration related symptoms in children Literature review (1992-2011, 29 papers) 19 countries, 116.000 children (age: 6-18y) Self-reported low back pain (ever) Self-reported low back pain (last year) 70% 60% y = 0.0334x - 0.1154 R² = 0.1639, p<0.05 70% 60% y = 0.063x - 0.5581 R² = 0.5391, p<0.01 50% 50% 40% 40% 30% 30% 20% 20% 10% 10% 0% 8 9 10 11 12 13 14 15 16 Age 0% 8 9 10 11 12 13 14 15 16 Age : spinal pain was reported
Primary prevention when? N = 771
Symptomatic childhood predicts symptomatic adulthood Groups (1994) LBP in 1994 (%) 12-15y old 16 2 16-19y old 40 7 20-22y old 50 10 male 32 5 female 38 7 LBP>30 days in 1994 (%) Days with LBP in 1994 LBP in 2002* (Odds Ratio) 0 1.00 1.00 1-7 1.60 1.15 8-30 2.40 1.43 >30 4.26 3.57 *adjusted for age and gender LBP>30 days in 2002* (Odds Ratio)
Risk factors for back pain associated with school Literature review (1997-2011, 27 papers) 19 countries, 59.000 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
Physical activity and LBP N=9,413 Isometric back muscle endurance Sport activity: NS
N=439
N=7542
N=546
N=26,766 (61.4%)
Posture Role of sagittal and frontal alignment
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) 1.00 1.5 1.8 1.8
Primary prevention programs Bio-psycho-social model Functional capacity Enviroment Behavior and psyho
Primary prevention programs N=398
N=497, Age=8y Comic Book of the Back Lasting effect on knowledge
Registered RCT (NCT00373009) Level A Young soldiers Primary prevention program Ex: LBP limited work/activity, >48h, seek health care Department of Defense (US)
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!
Thank you!