does minor trauma cause serious low back illness.pptVIP

Minor Trauma, New MRI Changes and Serious Low Back Illness? Eugene J. Carragee, MD Professor, Department of Orthopaedic Surgery Stanford University School of Medicine What Causes Serious Low Back Pain Illness and Disability? Definite Causes of LBP: Serious Disease (Fracture, Tumor, Infection, etc) Possible Causes: Specific structural lesion Disc, anulus Facet Endplate Social context (compensation, etc) Neurophysiologic Abn (Central pain/sensistivity) Psychological / Emotional Reserves Minor Trauma Combinations Most frequently implicated: Minor trauma and pre-existing DDD Minor Trauma and DDD Questions??? Does minor trauma cause serious injury to degenerated discs (anular tear?) Do persons with DDD + minor trauma have a greater risk of serious LBP illness than without minor trauma? (Is a LBP event going to happen anyway…regardless of trauma) No study has prospectively looked at minor trauma events in subjects with documented MRI DDD without serious LBP. Stanford LBP Cohort Study Objective To assess whether the occurrence of common minor trauma events affects the risk of developing serious LBP and LBP disability in subjects with and without degenerative changes to the lumbar spine. Primary Hypothesis Minor trauma is an independent risk factor of subsequent disabling LBP episodes among persons without LBP histories but with known risk factors for degenerative disc disease. Secondary Hypothesis In the presence of minor trauma, the effects of psychological and structural factors are not independent risk factors of subsequent disabling LBP. Study Design and Population Study Design Five-year prospective cohort study with assessments by blinded research assistant every six months. Study Population Working subjects with known risk factors for degenerative lumbar disc disease but without histories of clinically important LBP episodes. Sampling Stratification ratio of 1:1 with and without chronic non-lumbar pain on a consecutive case basis. Eligibility Criteria Inclusi