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Background: Nonspecific back pain in children is nearly as common as in adults but is associated with a number of age-specific risk factors including female gender, a family history of low back pain, a high level of physical activity, and prolonged sitting., Objective: To investigate potential school-related risk factors for back pain in children, most notably schoolbag weight expressed as a percentage of body weight (relative schoolbag weight), whether the schoolbag is carried by hand or by a shoulder harness, how the child travels to and from school, and sitting positions., Patients and Methods: 123 eighth-graders, 58 girls and 65 boys, with a mean age of 14 +/- 0.6 years, completed an anonymous self-questionnaire during a school day involving six hours of classes. Their schoolbag was weighed on the same day., Results: Most respondents traveled to and from school in a vehicle (70%), made one trip in each direction each day (75%), and carried their schoolbag by the shoulder harness (92%). The prevalence of back pain on the study day was 27.6%, whereas the cumulative prevalence for the last 12 months was 82.9% with 16.3% of respondents reporting a single episode of pain, 57.7% recurrent pain, and 8.9% chronic pain. A need for a physician visit for back pain was reported in 18.7% of cases, and 14.6% of respondents had missed school and/or sporting activities because of back pain. Female gender was associated with current back pain (odds ratio [OR], 2.7; 95% confidence interval [CI], 1.2-6.1). A relative schoolbag weight of 20% or more was associated with a history of back pain (OR, 3.1; 95% CI, 1.0-9.2), and this effect was larger in children who traveled to and from school on foot and in those who carried their schoolbag in their hand. Sitting on the edge of the chair while completing the questionnaire was significantly associated with a history of a physician visit for back pain (OR, 3.1; 95% CI, 1.0-9.5). Neither handedness nor the position of the questionnaire on the table were significantly associated with back pain in our study population., Conclusions: The findings from this cross-sectional study indicate a need for a longitudinal prospective study designed to identify etiologic and prognostic factors of back pain in adolescents, with the goal of devising preventive strategies likely to reduce the risk of low back pain in adulthood.

Objective: To evaluate the influence of genetic background as a determinant of peak bone mass., Patients and Methods: We compared lumbar spine bone mineral density in 175 girls with a bone age of 16 years or older and in their premenopausal mothers. We also investigated the influence of a family history of osteoporosis on lumbar spine bone mineral density in 275 women and their 559 daughters., Results: In the 175 mother-daughter pairs, heritability (h2) was significantly different from 0 (P < 0.0001) for lumbar spine bone mineral density (h2 = 53%; 95% confidence interval [95% CI] = 28.5-77.6%), bone mineral content (h2 = 62.3%; 95% CI = 37.7-86.8%), bone mineral density adjusted for body mass index (h2 = 56%; CI = 31.5-80.5%), and bone mineral content adjusted for body mass index (h2 = 68.2%; CI = 43.6-92.7%). However, the heritability estimations lacked accuracy, as shown by the wide 95% CIs. Osteopenia and osteoporosis were found in 16.4% and 1% of the mothers, respectively. In the subgroup defined by osteopenia or osteoporosis in the mother, lumbar spine bone mineral density was significantly higher in the daughters than in the mothers (0.994 +/- 0.095 g/cm2 versus 0.895 +/- 0.098 g/cm2; P < 0.0001), whereas the opposite was true in the subgroup defined by normal bone mass in the mothers (1.068 +/- 0.110 g/cm2 versus 1.109 +/- 0.098 g/cm2; P = 0.0003). Nevertheless, lumbar spine bone mineral density was significantly lower in the daughters of low-bone-mass women than in those of normal-bone-mass women (0.994 +/- 0.009 g/cm2 versus 1.069 +/- 0.012 g/cm2; P = 0.0006). These findings suggest a role of genetic factors inherited from the father and also indicate that bone mass gains during adulthood contribute to achievement of the optimal peak bone mass. In the family history study, bone mass was lower in the subjects with a family history of osteoporosis (123 of the 559 daughters, Z-scores normalized for height, weight, and pubertal status: bone mineral density Z-score, -0.054 +/- 1.104; bone mineral content Z-score, -0.014 +/- 1.079; 58 of the 275 mothers: bone mineral density, 1.048 +/- 0.107 g/cm2; bone mineral content, 43.3 +/- 6.8 g) than in those without a family history of osteoporosis (436 daughters, bone mineral density Z-score, 0.006 +/- 0.981; bone mineral content Z-score, -0.007 +/- 0.985; 217 mothers: bone mineral density, 1.070 +/- 0.127 g/cm2; bone mineral content, 43.8 +/- 6.7 g); however, none of these differences were statistically significant., Conclusion: Our findings challenge the currently popular concept of marked bone mass heritability but are consistent with early genetic influences on lumbar spine bone mass. Thus, optimization of the peak bone mass acquired during growth may help to prevent osteoporosis.

Objective: Insurance companies are showing considerable interest for measurement devices claimed to be effective in evaluating risks associated with occupational or sporting activities. The aim of this study was to evaluate the potential influence of spinal morphology on the risk of low back pain., Methods: 1500 male construction work apprentices aged 16 to 23 years underwent spinal measurements at the Caen Teaching Hospital from 1991 to 1996. The 384 subjects with abnormal measurements or a history of spinal pain underwent plain radiography and a second set of spinal measurements done by a different examiner using a different device. The following radiological parameters were studied: incidence angle, junction couple, Ferguson's index, L1-L5 lordosis angle and L1-S1 lordosis angle., Results: In the 152 retrospectively studied subjects, no significant differences in static spinal parameters were found between subjects with and without a history of low back pain. The type of lordosis was correlated with the incidence angle but not with the junction couple., Conclusion: In our population, spinal measurements were not correlated with a specific morphological pattern of the lumbar spine or pelvis, and neither was a history of low back pain correlated with a specific pattern of lumbar and pelvic balance.

Objective: To evaluate the contribution of laboratory tests, histology and scintigraphy for diagnosing and monitoring the treatment of lower limb arthroplasty infection., Patients and Methods: 37 lower limb arthroplasties, 20 at the hip and 17 at the knee, were studied. Investigations included laboratory tests for inflammation (erythrocyte sedimentation rate, C-reactive protein, haptoglobin, and orosomucoid), histology (presence of neutrophils) and scintigraphy (99m Tc-HMDP bone scan, colloidal sulfide bone marrow scan, and 99m Tc-HMPAO leukocyte scan). Follow-up was at least three years after treatment of the infection., Results: Acute phase reactants were more sensitive and more specific than the erythrocyte sedimentation rate. The full scintigraphy protocol had 100% sensitivity and 87% specificity. Recovery of neutrophils by aspiration or during surgery was 100% specific in the absence of hematomas or rheumatoid arthritis. Sensitivity of the presence of neutrophils varied with the collection technique.

Whereas radiographic lesions of the sacroiliac joints are common in patients with calcium pyrophosphate deposition crystal disease, they are rarely accompanied with clinical symptoms. We report two cases of acute sacroiliitis probably due to calcium pyrophosphate dihydrate deposition disease. The patients were a 53-year-old man and an 82-year-old woman with chondrocalcinosis in other joints and presence on computed tomography studies of the sacroiliac joints of sclerosis and irregularities of the joint margins with a thin linear calcific deposit within the joint. Both patients recovered fully under therapy with colchicine, analgesics and rest. These two cases suggest that acute sacroiliitis can be caused by calcium pyrophosphate dihydrate crystal deposition disease.

We report two cases of cerebral venous thrombosis that occurred after an intrathecal glucocorticoid injection for common lumbosciatic syndrome. The patients were two females, aged 34 and 47 years, who developed typical post-lumbar puncture headache. The manifestations leading to the diagnosis of cerebral venous thrombosis were status epilepticus in one case and persistent headache in the other. Both patients were using oral contraceptives. Grynblat et al. (Rev Rhum [Engl Ed] 1995; 62: 691) recently reported two cases in young women of cerebral venous thrombosis after intrathecal administration of a glucocorticoid or an iodinated contrast agent. These cases are useful reminders that intrathecal glucocorticoid injections can be followed by cerebral venous thrombosis, and that younger women may be at increased risk for this complication.

Hematogenous infection of the facet joints by pyogenic organisms is exceedingly rare. We report six cases of lumbar facet joint septic arthritis due to hematogenous spread of a pyogenic organism. A review of the literature identified ten anecdotal reports of similar cases. An analysis of these 16 cases showed that the diagnosis was based mainly on imaging study findings and that clinical data failed to discriminate between facet joint septic arthritis and infectious discitis. Increased uptake on the radionuclide bone scan was an early finding and the pattern of uptake was different from that seen in discitis. Computed tomography was the investigation that best delineated the facet joint lesions. Magnetic resonance imaging of the lumbar spine was superior over computed tomography in demonstrating spread of the infection to the epidural space and/or soft tissues and in some instances demonstrated enhancement of the infected facet joint on T1 images after gadolinium injection. Aspiration of the facet joint under fluoroscopic guidance was required only when blood cultures were negative or when the diagnosis of the septic nature of the arthritis was in doubt. Blood cultures yielded a Staphylococcus aureus in the six cases in our series. Appropriate antimicrobial therapy was successful in most cases. In our series, four of the six patients had posterior epiduritis, pyomyositis, or an abscess in the paraspinal muscles or psoas muscle, suggesting that some epidural infections or psoas muscle abscesses believed heretofore to be primary may in fact be complications of facet joint septic arthritis. Facet joint septic arthritis is a new aspect of pyogenic spinal infections that deserves to be considered in patients with febrile spinal syndromes not explained by discitis.