Oral Presentation 51st International Society for the Study of the Lumbar Spine Annual Meeting 2025

Introduction: Considering the increasing prevalence of pediatric back pain, spinal degenerative changes in children and adolescents have become an area of growing concern. Factors related to modern lifestyle such as prolonged sedentary behaviors, poor posture during screen use, and insufficient, or even high but only uniform physical activity, may contribute to early signs of spinal problems in children and adolescents. The aim was therefore to report on spinal changes on magnetic resonance imaging (MRI) in healthy adolescents and to identify potential associations to physical activity, screen time and back pain.  

Methods: From a prospective birth cohort project on factors influencing growth and health in Swedish children (n=551), a sub-cohort (n=81) underwent whole body MRI at the age of 6 years. At the age of 14, all participants in the sub-cohort were invited to the current study, including MRI of the entire spine and questionnaires regarding physical activity, screen time and pain. Changes of the intervertebral disc (Pfirrmann grade, high intensity zones (HIZ)) and of the vertebra and/or endplate (endplate score, Modic changes, Schmorl’s nodes, apophyseal injuries and spondylolisthesis) were evaluated on sagittal T1- (TR579.0/TE9.3) and T2-weighted (TR3650/TE107.7) MRI sequences (Signa, Explorer 1.5T GE healthcare). To enable comparison between individuals with various grade of degenerative findings, the participants were stratified into three groups; No changes; Pfirrmann grade I-II all discs, endplate score ≤4 all endplates and no other findings, Mild degenerative changes; 1-2 findings in 1 or 2 of the of the following parameters: Pfirrmann grade III-V, HIZ, endplate score≥5, Modic changes, Schmorl's nodes, apophyseal injury and/or spondylolisthesis, Moderate/prominent degenerative changes; ≥3 findings according to the same criteria. The groups were compared to the parameters in the questionnaires. Gwet’s statistics were used for intra/inter reliability measures for MRI parameters.

Results: Sixty-nine adolescents (48% boys), with a mean (SD) age 14.4 (0.2) years and BMI 21.9±3.4, underwent MRI of whom 63 answered the questionnaires. Fifty-two percent had no changes while 28% had mild degenerative changes and 20% had moderate/prominent degenerative changes, details of MRI changes are displayed in figure 1. Seventy-seven percent exercised regularly with 30% having more than 5 exercise sessions/week. Hours of screen time/day (outside of school) was in mean (SD) 4.4 (2.0) respectively per week 34.9 (15.0). Fifty-six percent denied having neck and/or back pain. No correlations between degenerative changes and screen time, physical activity and pain were detected (table 1). Weighted Gwen’s estimates for intra-observer classifications ranged between 0.80-0.92 and between 0.78-0.92 for inter-observer measures.

Discussion: In this cross-sectional cohort of healthy 14-year-old adolescents close to 50% displayed degenerative spinal changes of various grade and neck/back pain was a common complaint. No correlation between degenerative findings and physical activity, screen time nor pain could be found. This study emphasizes the need to continue to investigate causal factors, beyond excessive physical activity/inactivity and screen time, in the development of degenerative spinal changes, especially given the anticipated long-life expectancy in this cohort and substantial risk for recurrence of back pain and continuation into adulthood.