The purpose was to investigate back pain and disability and their relationship to vertebral changes in patients with untreated Scheuermann's.

Overall, 136 patients who had attended the outpatient clinics between 1950 and 1990 for Scheuermann's were contacted, 49 of them (12 females, 37 males) responded. There was no difference in the baseline data between responders and non-responders. From radiographs, th-kyphosis, l-lordosis, and scoliosis were measured. The number of affected vertebrae and the degree of wedging were registered. Anthropometric data, occurrence of back pain, disability scores, and employment status were compared to a representative sample (n=3835) of the normal population.

After mean follow-up of 37 (6.5;25.9-53.7) y, their average age was 58.8 (8.2;44.4.-79.3) y. Male patients were significantly taller than the control subjects. Female patients were on average 6 kg heavier (P=0.016) and their mean BMI was higher (23.9 kg/m² vs 20.8 kg/m²,P=0.001) at age 20 than in the controls.

Females had a greater mean kyphosis than males (51.7 vs. 43.2°, p=0.11). There was no correlation between the degree of thoracic kyphosis and disability. Scheuermann's patients had an increased risk for constant back pain (P=0.003), a 2.6-fold risk for disability because of back pain during the past 5 years (P=0.002), a 3.7-fold risk for back pain during the past 30 days (P<0.001), and a 2.3-fold risk for sciatic pain (P=0.005). They reported a poorer quality of life (p<0.001) and general health (p<0.001). There was no difference in working ability and employment status between patients and controls.

Aims: Both clinical and epidemiologic studies have shown an association between atherosclerotic changes in the aorta or lumbar arteries and lumbar disc degeneration. However, the association between atherosclerosis and sciatica is unknown. The aim of this study was to investigate the association between carotid intima-media thickness (IMT) and clinically defined sciatica in a representative population sample.

Methods: The target population consisted of people aged 45–74 years who had participated in a nationwide Finnish population study during 2000–2001 and lived within 200 kilometres from the six study clinics. Of the 1867 eligible subjects, 1386 (74%) were included in the study. High-resolution B-mode ultrasound imaging was used to measure IMT. Local or radiating low back pain (LBP) was determined by a standard interview and clinical signs of sciatica by physician’s clinical examination.

Results: Carotid IMT was associated with continuous radiating LBP and with a positive unilateral clinical sign of sciatica. The associations were seen only in men; after adjustment for potential confounders, each standard deviation (0.23 mm) increment in carotid IMT showed an odds ratio of 1.6 (95% confidence interval 1.1–2.3) for continuous radiating LBP and 1.7 (95% confidence interval 1.3–2.1) for a positive unilateral clinical sign of sciatica. This latter association was observed in subjects with and in those without exposure to physical work load factors. Carotid IMT was not associated with local LBP.

Conclusions: Sciatica may be a manifestation of atherosclerosis, or both conditions may share common risk factors.

The aim of the study was to assess the effectiveness of surgical treatment for degenerative lumbar spinal stenosis (LSS) as compared with non-operative measures. Four university hospitals contributed, after agreement on study protocol, surgical rationale and non-operative procedures (For details, see Spine2007;32:1–8). Ninety-four patients were randomized into a surgical or nonoperative treatment group, 50 and 44 patients, respectively. Surgery comprised undercutting laminectomy of the stenotic segments, in 10 patients augmented with transpedicular instrumented fusion. The primary outcome was based on assessment of functional disability using the Oswestry Disability Index (ODI, scale 0–100). Intensity of leg and back pain (scales 0–10), as well as self-reported walking ability, were recorded at randomization and at follow-ups at 6, 12, 24 months and on average 6 years after the randomization. At the 2-year follow-up, back and leg pain scales and ODI had improved more in the surgical than the nonoperative group (p-values for global difference < 0,01). At the 6-year follow-up the mean difference in ODI in favor of surgery was 9.5 (95% confidence interval 0.9–18.1). However, the intensity of pains did not any-more differ between the two treatment groups at the 6-year follow-up. Walking ability did not differ between the treatment groups at any time point. Of the 44 patients in the nonoperative group, 4 had been subjected to surgery within two years after randomization because of persistent symptoms.

We conclude that surgical treatment improves functional ability in lumbar spinal stenosis. We emphasize that improvement also occurs after nonoperative measures. We recommend starting treatment with non-operative measures during a 2-year surveillance period, as during this period only 10 per cent of the patients will need surgical intervention.

Since neurological claudication is a major symptom in lumbar spinal stenosis (LSS), walking distance is commonly used as a measure of the severity and surgical outcome in LSS. The aim of this study was to compare self-reported and treadmill-measured walking distances in a trial, in which 94 patients with moderate LSS had been randomized into conservative and surgical treatment. Among the 44 patients in conservative treatment, the treadmill-measured walking distance was more reproducible after 6 months than the self-reported distance; the intraclass correlation coefficients were 0.75 and 0.41, respectively. Among all the patients at baseline, the agreement between self-reported and measured walking distance was satisfactory (intraclass correlation 0.57), although male patients overwhelmed their performance by 200 meters. Such a shift was not found in women. For walking distance categorized as < 400, 400–1249 and ≥ 1250 meters, there was a fair agreement between self-report and treadmill (weighed kappa 0.42). However, when the analysis was restricted to those whose walking distance was restricted to < 1250 meters, the corresponding agreement was poor (intraclass correlation 0.26). The self-reported walking distance was closely correlated with Oswestry index at baseline (r = 0.26), and changes in these outcomes from randomization to the follow-up of 6 months showed a strong correlation with each other (r = 0.37). We conclude that walking distance is a fundamental element of disability in LSS. Self-reported walking distance seems to be an appropriate clinical tool, but its limited precision in relation to treadmill-measured distance must be considered, when walking ability is severely restricted.

Aims: Prevalence and risk factors of osteoarthritis in the carpometacarpal joint of the thumb have been amply explored in previous studies. However, no study has focused on CMC OA as a predictor of disability and mortality. We investigated CMC OA for its associations with risk factors, disability and with life expectancy in a extensive health survey. Methods: In 1978–80, a representative population sample of 8,000 Finns aged 30 or over were invited to participate in a comprehensive health examination; 90% complied. Hand radiographs were taken from 3,595 subjects and the clinical status was completed for 3,434 subjects. By the end of 1994, 897 subjects with hand radiographs had died. Results: The age adjusted prevalence rate of CMC OA of Kellgren’s grade 2 to 4 was 7% for men and 15% for women. Adjusted for alleged risk determinants, body mass index was directly proportional to the prevalence of CMC OA in both sexes, OR =1.29 (95% confidence interval 1.15–1.43) per each increase of 5 kg/m2 in body mass index. Smoking seemed to carry a protection against CMC OA in men but not in women. No significant association was found between history of workload and CMC OA. Restricted mobility, tenderness and swelling were frequently found in the presence of radiological CMC OA, but no significant increase occurred in the prevalence of disability. In men CMC OA of Kellgren’s grade 3 to 4 significantly predicted total mortality (adjusted relative risk 1.32, 95% confidence interval 1.03–1.69). Conclusion: In line with previous studies, body mass index strongly determines the prevalence of CMC OA. CMC OA is highly prevalent, but its impact on disability in the general population is scanty.