Objective
To provide a single source for the best available estimates of the US prevalence of and number of individuals affected by osteoarthritis, polymyalgia rheumatica and giant cell arteritis, gout, fibromyalgia, and carpal tunnel syndrome, as well as the symptoms of neck and back pain. A companion article (part I) addresses additional conditions.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/art.23177

Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II.

OBJECTIVE
To provide a single source for the best available estimates of the US prevalence of and number of individuals affected by osteoarthritis, polymyalgia rheumatica and giant cell arteritis, gout, fibromyalgia, and carpal tunnel syndrome, as well as the symptoms of neck and back pain. A companion article (part I) addresses additional conditions.


METHODS
The National Arthritis Data Workgroup reviewed published analyses from available national surveys, such as the National Health and Nutrition Examination Survey and the National Health Interview Survey. Because data based on national population samples are unavailable for most specific rheumatic conditions, we derived estimates from published studies of smaller, defined populations. For specific conditions, the best available prevalence estimates were applied to the corresponding 2005 US population estimates from the Census Bureau, to estimate the number affected with each condition.


RESULTS
We estimated that among US adults, nearly 27 million have clinical osteoarthritis (up from the estimate of 21 million for 1995), 711,000 have polymyalgia rheumatica, 228,000 have giant cell arteritis, up to 3.0 million have had self-reported gout in the past year (up from the estimate of 2.1 million for 1995), 5.0 million have fibromyalgia, 4-10 million have carpal tunnel syndrome, 59 million have had low back pain in the past 3 months, and 30.1 million have had neck pain in the past 3 months.


CONCLUSION
Estimates for many specific rheumatic conditions rely on a few, small studies of uncertain generalizability to the US population. This report provides the best available prevalence estimates for the US, but for most specific conditions more studies generalizable to the US or addressing understudied populations are needed.

National Arthritis Data Work-group. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II

Low back pain is a symptom that cannot be validated by an external standard. It is a disorder with many possible etiologies, occurring in many groups of the population, and with many definitions. Low back pain is a common problem, with a prevalence in the United States ranging from 8% to 56%. It is estimated that 28% experience disabling low back pain sometime during their lives, 14% experience episodes lasting at least 2 weeks, 8% of the entire working population will be disabled in any given year, and the lifetime prevalence of low back pain is 65% to 80%. It is believed that most episodes of low back pain will be short-lived and that 80% to 90% of attacks of low back pain resolve in about 6 weeks, irrespective of the administration or type of treatment. However, multiple studies in the late 90s showed recurrent or chronic low back pain, evaluated at 3 months, 6 months, or 12 months, ranging from 35% to 79%. Risk factors of low back pain are multifactorial, with many possible etiologies. Multiple risk factors of low back pain and lower-extremity pain include physical factors, social demographic characteristics, habits, and psychosocial factors. This review will discuss the epidemiology of low back pain, with emphasis on frequency, causes, and consequences of low back pain; the influence of age, gender, morphologic characteristics, and genetics; and the influence of occupational, mechanical, social, habitual, and psychological factors.

/pdf/epidemiology-of-low-back-pain-2x2sguf786.pdf

Epidemiology of low back pain.

Clinical spinal instability and low back pain

Fifty patients who had spinal stenosis associated with degenerative lumbar spondylolisthesis were prospectively studied clinically and radiographically to determine if concomitant intertransverse-process arthrodesis provided better results than decompressive laminectomy alone. There were thirty-six women and fourteen men. The mean age of the twenty-five patients who had had an arthrodesis was 63.5 years and that of the twenty-five patients who had not had an arthrodesis, sixty-five years. The level of the operation was between the fourth and fifth lumbar vertebrae in forty-one patients and between the third and fourth lumbar vertebrae in nine patients. The patients were followed for a mean of three years (range, 2.4 to four years). In the patients who had had a concomitant arthrodesis, the results were significantly better with respect to relief of pain in the back and lower limbs.

Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis.

This study was undertaken because there is a dearth of objective information in the literature on the clinical instability of the cervical spine below C2. To our knowledge, it is the first biomechanical investigation designed to analyze clinical stability. We have carried out a quantitative analysis of the behavior of the spine as a function of the systematic destruction of various anatomic elements. Under controlled conditions designed to maintain the biological integrity of the specimens, 17 motion segments from 8 cervical spines were analyzed. The spines were studied with either flexion or extension simulated using physiologic loads. Some of the more important findings are: (1) In sectioning the ligaments, one observes small increments of change followed without warning by sudden, complete disruption of the spine; (2) Removal of the facets alters the motion segment such that in flexion, there is less angular displacement and more horizontal displacement; (3) The anterior ligaments contribute more to stability in extension than the posterior ligaments and in flexion, the converse is true; (4) The adult cervical spine is unstable, or on the brink of instability, when any of the following conditions are present: a) All the anterior or all the posterior elements are destroyed or unable to function. b) More than 3.5 mm horizontal displacement of one vertebra in relation to an adjacent vertebra measured on lateral roentgenograms (resting or flexion-extension). c) More than 11 degrees of rotation difference to that of either adjacent vertebra measured on a resting lateral or flexion-extension roentgenogram. These findings can be aptly applied to clinical situations and when instability as determined by the above criteria is present, surgical fusion or some other method to achieve stability should be seriously considered. Work is continuing on this problem as we do not consider this to be altogether complete or definitive. Hopefully, this initial study will stimulate further scientific and clinical investigations.

Biomechanical analysis of clinical stability in the cervical spine.

Disorders of the lumbar spine are among the most common medical problems in western countries, affecting up to 80% of people at some time during their lives. The epidemiology and impact of six specific disorders of the lumbar spine are reviewed. These include prolapsed discs, disc degeneration, osteoarthrosis of the apophyseal joints, fractures and dislocations of vertebrae, osteoporosis, and spondylolisthesis. Various mechanical factors contribute to the causation of most of these disorders, but other underlying pathologic mechanisms are important as well. In light of the great impact of these conditions on society and on individuals, it is concluded that there is a considerable need for a greater allocation of resources for improvement in methods of prevention, diagnosis, and treatment.

Epidemiology and impact of low-back pain

Eighteen Functional Spinal Units (FSU), representing three levels of human lumbar and lumbosacral spine, were tested using preload forces that corresponded to the clinical situation of a person lying supine or standing while subjected to maximum physiologic flexion or extension forces. Sagittal plane displacements were measured using linear variable differential transformers (LVDTs) and a MINC-11/03 minicomputer. Sequential transection of components in the posterlor­ to-anterior and anterior-to-posterior directions until failure occurred allowed measurements of the displacement sagittal plane translation and rotation of the Intact and transected FSU [Key words: lumbar spine, stability, flexion. extersion, preload]

A Biomechanical Analysis of the Clinical Stability of the Lumbar and Lumbosacral Spine

Synopsis: workshop on idiopathic low-back pain.

Clinical failures of internal fixation implants for the treatment of the thoracolumbar spine are generally attributed to fatigue. Few studies, however, have characterized changes in fixation rigidity with time or subjected spine-implant fixation constructs to fatigue loading until failure. Fatigue characteristics of five dorsally applied spinal fixation implants were determined using lumbosacral calf spines, with an L3 vertebrectomy, loaded cyclically in combined compression (maximum 605 N) and flexion (maximum 16 Nm) for up to 100,000 cycles. Displacement transducers monitored motion at the site of instability and at the segment above the implants. Flexibility and strain at these segments were then calculated. A one-way analysis of variance showed that there were no significant differences in flexibility of the five fixation constructs (P greater than .05). A multiple Bonferroni test revealed that the AO and Kluger fixateur interne and Steffee plates, with fixation at L2 and L4, allowed significantly more strain (P less than .01) across the site of instability than did Harrington rods and Luque plates with fixation at L1, L2, L4, and L5. There were no significant differences between fixation constructs in initial strain above the implants. After 10,000 cycles, however, there were significant increases in strain across the segment above the Luque and Harrington implants (P less than .05). Failure of the AO Schanz screw occurred in three of six constructs at a mean of 73,300 cycles. The Steffee screws failed in four of five constructs at a mean of 20,800 cycles. The rods of the Kluger fixateur interne broke in four of five constructs at a mean of 47,800 cycles, and one screw slipped at 11,000 cycles. There were no metal failures in the Harrington or Luque implants.(ABSTRACT TRUNCATED AT 250 WORDS)

A biomechanical study of the fatigue characteristics of thoracolumbar fixation implants in a calf spine model.

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