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Population & Epidemiology

Global prevalence and incidence of musculoskeletal and spinal disorders, focusing on demographic drivers and regional variations in disability burden.

Overview

Life course epidemiology concepts facilitate the study of back pain [1]. For pleomorphic liposarcoma, older age associates with poor overall survival but not disease-specific survival [2]. Metastatic bone disease survival has likely improved due to advances in medical and surgical treatments [6]. The North Staffordshire Osteoarthritis Project (NorStOP) is a prospective, 3-year study determining the course, prognosis, and impact of clinical osteoarthritis on participation and health care use in older adults [7].

Upper-extremity musculoskeletal disorders (UEDs) show substantial differences in reported prevalence rates, mainly due to the absence of a universally accepted way of labelling or defining UEDs [10]. The first comprehensive North American population-based incidence of elbow dislocations highlights the clinical burden and raises questions about outcomes [3]. Prevalence and incidence estimates for doctor-diagnosed Dupuytren’s disease are useful for healthcare planning and resource allocation [8].

Despite evidence of sociodemographic factors' importance on surgical outcomes, there is a surprising absence of sociodemographic data within contemporary RCTs in spine surgery, which potentially biases the generalizability of outcome data [25]. Studies need to include an equal number of male and female patients and be sufficiently powered to answer research questions for both sexes separately, with all raw data published disaggregated for sex and gender to improve the reporting of outcomes [45]. Congressionally directed research funding will be constructive in the short term by emphasizing projects using relevant populations and approaches that benefit patients soon, defining best practice guidelines and fielding new therapies to reduce complications and improve outcomes [12]. The AAOS developed Appropriate Use Criteria to guide clinicians in determining the appropriateness of prophylactic antibiotics for 64 patient scenarios based on evidence and expert opinion [19].

Anatomy & Pathophysiology

Osseous and Structural Degeneration

Osteophyte development follows a fairly constant pattern characteristic of each spinal region, with anterior osteophytes being more frequent and developed than posterior ones [31]. Chronic low back pain in males is associated with some lumbar vertebral bone mineral density (BMD) measures [66]. Immobilization induces intervertebral disc degeneration involving changes at the macroscale, microscale, and nanoscale [40].

Alignment and Kinematics

There is a relationship between sagittal spinal alignment and low back pain [75]. A decline in cervical lordosis curvature was observed in asymptomatic Chinese populations from 2016 to 2024 [67].

Epidemiology and Imaging

Thoracic spine pain is associated with numerous risk factors across biopsychosocial categories, including concurrent musculoskeletal pain, psychological factors, and specific postural or lifestyle factors [50]. Most individuals with persistent or recurrent low back pain adhere to a traditional biomedical perspective of anatomical or biomechanical causes for their pain [53]. Life course epidemiology concepts and methods could facilitate the study of back pain [1].

SpineNet offers potential to grade lumbar spinal stenosis in large-scale epidemiological studies with a high level of consistency and objectivity [21]. Few MRI findings showed large magnitude associations with symptom outcomes such as chronic low back pain or radicular symptoms [9].

Classification

Life Course Epidemiology: This conceptual framework can be adopted to facilitate the study of back pain [1].

Anatomic Variants: The study provides information to determine the prevalence of anatomic variants associated with femoroacetabular impingement in the general population [4].

HLA-B27 Status: The prevalence of HLA-B27 in the normal population is significantly lower in Middle Eastern and Arab countries than in Western countries [63].

Other Considerations: Substantial differences exist in reported prevalence rates of upper-extremity musculoskeletal disorders, mainly due to the absence of a universally accepted way of labelling or defining these disorders [10]. Prevalence and incidence estimates for doctor-diagnosed Dupuytren’s disease are useful for healthcare planning and resource allocation [8]. The study provides the first comprehensive North American population-based incidence of elbow dislocations [3]. The prevalence of ossification of the spinal ligaments in the Chinese population was revealed [26]. Differences in bone mineral density could potentially explain part of the urban-rural difference in fracture incidence [29]. Projections based on current trends estimate that the annual incidence of hamstring injuries will continue to rise through 2030 [30]. The epidemiology of scoliosis has regional variation, and genetic differences may contribute to such differences [56]. The incidence of knee osteoarthritis is significantly different with regions, age, and sex [60]. Prevalence rates of low back pain were constant over time at a group level, but did not necessarily involve the same individuals [18]. The correlation between scores on screening tools for risk classification of patients referred to secondary care for low back pain was good, while the classification agreement between the screening instruments was low [61]. A considerable difference exists in both the number of surgeons and the proportion of total knee arthroplasties conducted across various settlement types, with only 0.6% of billed total knee arthroplasties occurring in rural areas despite 20% of the population living there [62].

Clinical Presentation

Epidemiology and Demographics: Incidence trends vary significantly by condition and population. The incidence of elbow dislocations has been comprehensively established in a Canadian metropolitan health region [3]. Adolescent idiopathic scoliosis (AIS) treatment incidence has increased recently, particularly among male patients [5]. Concussion diagnoses in the general US population are rising, driven largely by a substantial increase in the adolescent age group [14]. Sex- and age-related differences exist in diagnoses and injury mechanisms for ankle-related basketball injuries treated in emergency departments [33]. Morphological variations associated with femoroacetabular impingement have a defined prevalence in the general population, specifically among asymptomatic hips in nonprofessional athletes [4]. Reported prevalence rates for upper-extremity musculoskeletal disorders show substantial differences, mainly due to the absence of a universally accepted definition [10].

Chronic Pain and Prognostic Indicators: Prevalence rates of low back pain remained constant over time at a group level, though this did not necessarily involve the same individuals [18]. In patients with pleomorphic liposarcoma, older age is associated with poor overall survival but not with disease-specific survival [2]. For persistent pelvic girdle pain 12 years postpartum, persistency and/or duration of pain symptoms, as well as widespread pain, appear to be the strongest predictors of poor long-term outcome [11]. In male patients with axial spondyloarthritis, age, gender, and symptom duration do not impact the longitudinal relationship between serum uric acid and patients' global assessment of disease activity [17].

Diagnostic Challenges and Comorbidities: Persons identified with criteria-based fibromyalgia have severe symptoms, but most (73%) have not received a clinical diagnosis [35]. The presence of comorbidities is associated with poorer care for low back pain [36]. Few MRI findings showed large magnitude associations with chronic low back pain or radicular symptom outcomes [9].

Screening and Triage: Guidelines for low back pain should emphasize early identification of "yellow flags" for disability in primary care [16]. The StarT back screening tool and a pain mannequin improve triage by identifying individuals with low back pain at risk of a worse prognosis, though they capture different aspects and numbers of high-risk individuals [32].

Investigations

Plain radiography: Radiographic assessment remains central to evaluating vertebral deformities, with the natural history of progression patterns for prevalent vertebral fractures in elderly individuals now clarified [13]. In the context of knee pathology, bilateral knee osteoarthritis is highly prevalent over time, as the majority of sufferers eventually develop radiographic disease in both knees [49].

MRI: Magnetic resonance imaging provides critical data for both spinal and joint pathologies. Morphological variations associated with femoroacetabular impingement have a defined prevalence in the general population, determined by a study of 1878 asymptomatic hips in nonprofessional athletes [4]. However, few MRI findings demonstrate large magnitude associations with spine-related symptom outcomes, even when applying specific definitions for those outcomes [9]. For large-scale epidemiological studies involving high volumes of MRI spine data, SpineNet offers the potential to grade lumbar spinal stenosis (LSS) with a high level of consistency and objectivity [21].

CT: The prevalence of ossification of the spinal ligaments (OSL) has been revealed in the Chinese population through a cross-sectional study of 2000 consecutive individuals [26].

Other Considerations: Epidemiological trends indicate that the incidence of adolescent idiopathic scoliosis (AIS) treatment has increased recently, particularly among male patients [5]. The incidence of concussion diagnosed in the general US population is increasing, driven largely by a substantial rise in the adolescent age group [14]. The incidence of anterior cruciate ligament reconstruction (ACLR) is increasing, especially among females and among younger cohorts under 20 years of age [58]. Conversely, surgical incidence after knee MRI was likely appropriately lower for older patients [34].

Risk stratification and population health challenges persist. Identifying the subset of osteoporotic patients with low bone mineral density (BMD) who require treatment remains a major clinical challenge [15]. Differences in bone mineral density potentially explain part of the urban-rural difference in fracture incidence [29]. Female gender, radiographic knee osteoarthritis, and low back pain at baseline are risk factors for lumbar disc height narrowing [51]. Substantial heterogeneity exists across musculoskeletal cohorts, suggesting that patient- and cohort-specific approaches to care may be more effective for achieving optimal health and outcomes [22]. Efforts to mitigate race-related disparities in spine care require individual, institutional, and national initiatives, as the musculoskeletal spine literature is limited in its understanding of the causes of race-related outcome trends [27]. Early detection and treatment reduced the risk of scoliotic curves progressing to 40 degrees or more by at least 63 per cent [59].

Treatment

Non-Operative

Most individuals reporting spinal pain manage without serious consequences [81]. For chronic low back pain, guidelines emphasize early identification of yellow flags in primary care to facilitate effective treatment allocation [16]. Future studies should focus on identifying specific patient groups to optimize this allocation [38]. In the military population, one-year response rates for web-based follow-up in low back pain prevention are significantly associated with demographic characteristics, health status, and individualized attention via additional testing [24]. For pediatric tibial spine fractures, most cases are treated nonoperatively [64]. In femoroacetabular impingement (FAI), successful management with return to play is achieved by both nonoperative and operative treatment methods [83].

Operative

Indications: Surgical management of coxa vara in childhood is indicated for progressive, painful, unilateral deformity or leg-length discrepancy, whereas moderate nonprogressive deformity often does not require surgery [69]. For pleomorphic liposarcoma, older age is associated with poor overall survival but not disease-specific survival [2]. In hip fracture, socioeconomic, patient-, and healthcare-related factors contribute to excess mortality, with non-modifiable factors showing a stronger association than modifiable ones [80].

Surgical Approach / Technique: The role of the team physician is evolving, requiring availability, trust, and the ability to navigate complex return-to-play decisions amidst external pressures while advocating for a balance between surgical and nonoperative management [70]. Understanding the current evidence and appropriate indications of emerging technologies in orthopaedic trauma is critical for their utilization [46].

Implant Selection: The AAOS developed Appropriate Use Criteria to guide clinicians in determining the appropriateness of prophylactic antibiotics for 64 patient scenarios based on evidence and expert opinion for patients with orthopaedic implants undergoing dental procedures [19].

Adjuncts: Congressionally directed research funding is constructive in the short term by emphasizing projects using relevant populations and approaches that benefit patients soon, defining best practice guidelines, and fielding new therapies to reduce complications and improve outcomes [12].

Other Considerations: Adoption of concepts and methods from life course epidemiology could facilitate the study of back pain [1]. Further research is warranted on the etiology behind the recent increased incidence of adolescent idiopathic scoliosis (AIS) treatment in male patients and the potential healthcare burden associated with projected future increases in AIS prevalence [5]. Longer survival after treatment of metastatic bone disease is likely attributable to improvements in both medical and surgical treatments [6]. In the Dutch setting of equal access to and provision of healthcare, survival hazards associated with household income can be attributed to patient and provider factors rather than disparities in healthcare [20]. Substantial heterogeneity across musculoskeletal cohorts suggests that patient- and cohort-specific approaches to patient counsel and care may be more effective for achieving optimal health and outcomes [22]. Contemporary randomized controlled trials (RCTs) in spine surgery have a surprising absence of sociodemographic data, which potentially biases the generalizability of outcome data despite evidence of the importance of sociodemographic factors on surgical outcomes [25]. Efforts to mitigate race-related disparities in spine care require individual, institutional, and national initiatives as the musculoskeletal spine literature is limited in its understanding of the causes of race-related outcome trends [27]. Failure to control disease activity, intensive treatment, and poor persistence with therapy predicted health care drop-out in an inception cohort of patients with early onset rheumatoid arthritis [41]. International orthopaedic trials have the potential to address a global burden of disease and optimize the benefit to patients in collaborating countries and those with similar health services and care systems [43]. The high prevalence of secondary osteoporosis in the Italian population indicates the importance of additional risk factors not yet included in the FRAX algorithm, for which preventive measures should be considered [48]. The demographics and practice patterns of orthopaedic surgeons caring for populations at the highest social risk remained consistent between years [78].

Complications

The provided evidence base does not contain specific data regarding surgical complications such as infection, aseptic loosening, instability, periprosthetic fracture, thromboembolism, patellar/extensor-mechanism issues, stiffness/arthrofibrosis, nerve palsy, wound complications, or polyethylene wear. Consequently, no subsections for these specific complication categories can be constructed from the available data.

Other Considerations: Survival and Prognosis: Older age is associated with poor overall survival in patients with pleomorphic liposarcoma [2], but is not associated with disease-specific survival in this population [2]. Pain and Functional Outcomes: Persistency and/or duration of pain symptoms are strong predictors of poor long-term outcome for pelvic girdle pain [11], as is widespread pain [11]. In outpatients with chronic low back pain, depression and anxiety at baseline are associated with greater disability at five-year follow-up compared to insomnia [28]. Epidemiology and Trends: The global burden of knee osteoarthritis has shown a consistent upward trend from 1990 to 2021, primarily driven by population growth and aging demographics [76]. The annual incidence of hamstring injuries in the United States is projected to continue rising through 2030 based on current trends [30]. The incidence of anterior cruciate ligament reconstruction increased between 1994 and 2006, particularly in females, those younger than 20 years, and those 40 years or older [74]. The lower than expected overall incidence rate of low back pain (0.05%) in young male military recruits reflects that severe occurrences are not common in this age group [79]. Healthcare System Factors: Elective inpatient total joint arthroplasty case volume in the United States decreased through December 2020 due to the effects of the COVID-19 pandemic [52]. Survival hazards associated with household income in the Dutch setting can be attributed to patient and provider factors rather than disparities in healthcare access [20]. Congressionally directed research funding aims to define best practice guidelines and field new therapies to reduce complications and improve outcomes [12].

Recovery

Light activity (weeks): Evidence does not specify a typical week range for light activity, desk work, driving, or light ADLs.

Full activity (months): Evidence does not specify a month range for manual work, sport, or full ROM/strength return.

Complete recovery / outcome plateau (months): Evidence does not specify a month range for the stabilization of pain, strength, and final functional outcomes.

Rehabilitation protocol: Evidence does not provide specific details on PT phasing, immobilisation duration, weight-bearing/ROM progression, or sling/brace removal timing.

Functional milestones: Functional ability and health-related quality of life improved after rehabilitation in a structured national rehabilitation program for patients with musculoskeletal disorders [47].

Other Considerations: Long-term outcomes vary by condition. Persistency and/or duration of pain symptoms as well as widespread pain appear to be the strongest predictors of poor long-term outcome for pelvic girdle pain 12 years postpartum [11]. Among individuals with long-lasting low back pain, high expectancies of returning to work were strongly associated with successful return to work [55]. The associations of depression and anxiety at baseline with disability at a five-year follow-up point among outpatients with chronic low back pain might be greater than that of insomnia at baseline [28]. Further studies with long-term follow-up are needed to determine whether the grafted area will maintain structural and functional integrity over time after Autologous Matrix-Induced Chondrogenesis for treatment of focal cartilage defects in the knee [42]. Mortality after geriatric hip fracture was independently associated with DNA methylation age, which was approximately 17 years greater than chronological age in the mortality cohort [84]. Older age is associated with poor overall survival in pleomorphic liposarcoma but not with disease-specific survival [2]. Longer survival after treatment of metastatic bone disease is likely attributable to improvements in both medical and surgical treatments [6].

Key Evidence

  • [L5] Adoption of concepts and methods from life course epidemiology could facilitate this. (10.1186/1471-2474-11-23)
  • [L3] Older age is associated with poor overall survival but not disease-specific survival. (10.1186/s13018-021-02327-3)
  • [L4] The study provides the first comprehensive North American population-based incidence of elbow dislocations, highlighting the clinical burden and raising questions about outcomes. (10.1111/j.1758-5740.2010.00084.x)
  • [L3] This study provides information to determine the prevalence of these anatomic variants in the general population. (10.1177/2325967120977892)
  • [L4] Further research is warranted on the etiology behind the recent increased incidence of AIS treatment in male patients and the potential healthcare burden associated with projected future increases in AIS prevalence. (10.5435/jaaos-d-25-00893)
  • [L4] Longer survival is likely attributable to improvements in both medical and surgical treatments. (10.5435/jaaos-d-23-00332)
  • [L4] This study protocol describes a three-year prospective cohort study designed to determine the course, prognosis, and impact of clinical osteoarthritis on participation and health care use in a general population of older adults. (10.1186/1471-2474-5-2)
  • [L3] The study provides prevalence and incidence estimates useful for healthcare planning and resource allocation. (10.1177/1753193416687914)
  • [L2] Even when applying more specific definitions for spine-related symptom outcomes, few MRI findings showed large magnitude associations with symptom outcomes. (10.1186/1471-2474-15-152)
  • [L1] There are substantial differences in reported prevalence rates on UEDs, mainly due to the absence of a universally accepted way of labelling or defining UEDs. (10.1186/1471-2474-7-7)
  • [L2] Persistency and/or duration of pain symptoms as well as widespread pain appear to be the strongest predictors of poor long-term outcome. (10.1186/s12891-017-1760-5)
  • [L5] The authors believe that congressionally directed research funding will be constructive in the short term by emphasizing projects using relevant populations and approaches that benefit patients soon, defining best practice guidelines and fielding new therapies to reduce complications and improve outcomes. (10.5435/00124635-201102001-00009)
  • [L2] This study clarified the natural history of the progression pattern of vertebral deformities in radiographic prevalent vertebral fractures in elderly individuals. (10.1186/s12891-024-07254-y)
  • [L4] The incidence of concussion diagnosed in the general US population is increasing, driven largely by a substantial rise in the adolescent age group. (10.1177/2325967116662458)
  • [L5] A major clinical challenge is identifying the subset of osteoporotic patients with low BMD who require treatment. (10.1002/jor.22626)
  • [L4] Guidelines should emphasize early identification of these yellow flags in primary care. (10.1186/s12891-022-05397-4)
  • [L2] Age, gender and symptom duration do not have an impact on the relationships. (10.1186/s12891-022-05657-3)
  • [L2] The prevalence rates of LBP, when defined in a number of ways, were constant over time at a group level, but did not necessarily involve the same individuals. (10.1186/s12891-016-1377-0)
  • [L5] The AAOS developed Appropriate Use Criteria to guide clinicians in determining the appropriateness of prophylactic antibiotics for 64 patient scenarios based on evidence and expert opinion. (10.5435/jaaos-d-17-00006)
  • [L2] Considering the equality of care provided by this study setting, the associated survival hazards can be attributed to patient and provider factors, rather than disparities in healthcare. (10.1371/journal.pone.0191464)
  • [L3] Thus SpineNet offers potential to grade LSS in large-scale epidemiological studies involving a high volume of MRI spine data with a high level of consistency and objectivity. (10.1186/s12891-020-3164-1)
  • [L4] The substantial heterogeneity across musculoskeletal cohorts suggests that patient- and cohort-specific approaches to patient counsel and care may be more effective for achieving optimal health and outcomes. (10.1186/1471-2474-14-83)
  • [L4] The results suggest that the natural history of idiopathic scoliosis may be becoming more benign spontaneously. (10.2106/00004623-199609000-00006)
  • [L2] One year response rate was significantly associated with demographic characteristics, health status, and individualized attention via additional testing. (10.1186/1471-2474-12-132)
  • [L2] Despite evidence of the importance of sociodemographic factors on surgical outcomes, this study identifies a surprising absence of sociodemographic data within contemporary RCTs in spine surgery, which potentially biases the generalizability of outcome data. (10.5435/jaaos-d-22-00838)
  • [L4] The prevalence of OSL in the Chinese was revealed. (10.1186/s12891-019-2569-1)
  • [L5] Efforts to mitigate race-related disparities in spine care require individual, institutional, and national initiatives, as the musculoskeletal spine literature is limited in its understanding of the causes of race-related outcome trends. (10.2106/jbjs.22.01155)
  • [L2] The associations of depression and anxiety at baseline with disability at the long-term follow-up point might be greater than that of insomnia at baseline. (10.1186/s12891-023-06682-6)
  • [L4] This difference could potentially explain part of the urban-rural difference in fracture incidence. (10.1186/1471-2474-6-5)
  • [L5] Projections based on current trends estimate that the annual incidence of these injuries will continue to rise. (10.1016/j.asmr.2025.101295)
  • [L3] Both screening tools identified individuals at risk, but they captured different aspects and different numbers of individuals at high risk of a worse prognosis. (10.1186/s12891-019-2836-1)
  • [L4] Sex- and age-related differences exist among diagnoses and injury mechanisms that involved ED visits. (10.1177/23259671251399846)
  • [L3] Surgical incidence after MRI was likely appropriately lower for older patients. (10.1177/23259671211052560)
  • [L3] Persons identified with criteria-based fibromyalgia have severe symptoms, but most (73%) have not received a clinical diagnosis of fibromyalgia. (10.1371/journal.pone.0138024)
  • [L3] The presence of comorbidities is associated with poorer care for low back pain. (10.1186/s12891-018-2316-z)
  • [L4] Future studies should focus on identifying this group to achieve effective treatment allocation. (10.1186/1471-2474-14-294)
  • [L5] The degeneration involved changes at the macroscale, microscale, and nanoscale, suggesting immobilization is not an innocuous strategy and may predispose to symptomatic spine development. (10.1186/s12891-018-2235-z)
  • [L2] Failure to control disease activity, intensive treatment, and poor persistence with therapy predicted health care drop-out. (10.1186/s12891-017-1670-6)
  • [L4] However, further studies with long-term follow-up are needed to determine whether the grafted area will maintain structural and functional integrity over time. (10.1007/s00167-010-1042-3)
  • [L5] International trials have the potential to address a global burden of disease, and in turn optimize the benefit to patients in the collaborating countries and those with similar health services and care systems. (10.1302/0301-620x.105b7.bjj-2023-0070)
  • [L5] Studies need to include an equal number of male and female patients and be sufficiently powered to answer research questions for both sexes separately, with all raw data published disaggregated for sex and gender to improve the reporting of outcomes. (10.1302/0301-620x.106b7.bjj-2024-0594)
  • [L3] Functional ability and health related quality of life improved after rehabilitation. (10.1186/1471-2474-14-57)
  • [L4] The high prevalence of secondary osteoporosis in the Italian population clearly indicates the importance of additional risk factors not yet included in the FRAX algorithm, for which preventive measures should be considered. (10.1186/s12891-016-1248-8)
  • [L2] Bilateral knee osteoarthritis is very common with time, as the majority of sufferers will eventually develop radiographic disease in both knees. (10.1186/1471-2474-13-153)
  • [L2] The review identified numerous associated and risk factors for thoracic spine pain across biopsychosocial categories, including concurrent musculoskeletal pain, psychological factors, and specific postural or lifestyle factors, though many associations were weak or inconsistent across studies. (10.1186/1471-2474-10-77)
  • [L2] This population-based cohort study quantitatively evaluated lumbar disc height using radiographic measurements and identified female gender, radiographic knee osteoarthritis, and low back pain at baseline as risk factors for disc height narrowing. (10.1186/s12891-015-0798-5)
  • [L3] The effects of the COVID-19 pandemic persisted through the end of that year, with decreased case volume through December 2020. (10.2106/jbjs.21.00833)
  • [L4] Despite continuing attempts to shift pain beliefs to more complex biopsychosocial factors, most people with LBP adhere to the traditional biomedical perspective of anatomical/biomechanical causes. (10.1186/s12891-017-1831-7)
  • [L2] Among individuals with long lasting low back pain high expectancies of returning to work were strongly associated with successful return to work. (10.1186/s12891-016-1314-2)
  • [L4] This study indicates that epidemiology of scoliosis has regional variation, and genetic differences may contribute such difference. (10.1186/s12891-016-1140-6)
  • [L4] These improvements were maintained at the nine-month follow-up. (10.2106/jbjs.m.00582)
  • [L3] The incidence of ACLR is increasing in Alberta, especially among females and among younger cohorts under 20 years of age. (10.1007/s00167-022-07093-1)
  • [L3] Early detection and treatment reduced the risk of scoliotic curves progressing to 40 degrees or more by at least 63 per cent. (10.2106/00004623-198163030-00002)
  • [L5] The incidence of knee osteoarthritis is significantly different with regions, age and sex. (10.1186/s12891-024-07191-w)
  • [L4] The correlation between score on the screening tools was good, while the classification agreement between the screening instruments was low. (10.1186/s12891-018-2082-y)
  • [L3] A considerable difference exists in both the number of surgeons and the proportion of TKAs conducted across various settlement types, with only 0.6% of billed TKAs occurring in rural areas despite 20% of the population living there, indicating a gap in orthopaedic care access. (10.5435/jaaos-d-24-00391)
  • [L1] The prevalence of HLA-B27 in the normal population is significantly lower in the Middle Eastern and Arab countries than in Western Countries. (10.1186/s12891-017-1639-5)
  • [L3] Most cases in this study were treated nonoperatively. (10.1016/j.asmr.2021.12.005)
  • [L3] CLBP in males is associated with some lumbar vertebral BMD measures, raising important questions about the mechanism and potential clinical impact of this association. (10.1186/1471-2474-13-49)
  • [L4] The findings of this study indicate a decline in cervical lordosis curvature over the past eight years. (10.1186/s12891-026-09510-9)
  • [L5] Surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy, while moderate nonprogressive deformity often does not require surgery. (10.5435/00124635-199803000-00003)
  • [L5] The author emphasizes that the role of the team physician is evolving, requiring availability, trust, and the ability to navigate complex return-to-play decisions amidst external pressures, while advocating for a balance between surgical and nonoperative management. (10.1177/0363546512468428)
  • [L3] The incidence of ACLR increased between 1994 and 2006, particularly in females as well as those younger than 20 years and those 40 years or older. (10.1177/0363546514542796)
  • [L4] This study shows a relationship between sagittal spinal alignment and LBP in Tanzania, which could allow for prospective identification of subjects prone to developing LBP in the future. (10.1186/s12891-019-2953-x)
  • [L1] The global burden of KOA has shown a consistent upward trend from 1990 to 2021, primarily driven by population growth and aging demographics. (10.1186/s13018-025-06140-0)
  • [L3] However, the demographics and practice patterns of the orthopaedic surgeons caring for populations at the highest social risk remained consistent between years. (10.2106/jbjs.24.01419)
  • [L3] The lower than expected overall incidence rate of 0.05% reflects that severe LBP occurrences are not common in this age group. (10.1186/s12891-016-1136-2)
  • [L2] Socioeconomic, patient-, and healthcare-related factors all contributed to excess mortality, and non-modifiable factors had stronger association than modifiable ones. (10.1302/0301-620x.104b7.bjj-2021-1806.r1)
  • [L4] Most people reporting spinal pain manage without any serious consequences. (10.1186/1471-2474-12-39)
  • [L3] The successful management of FAI with return to play was achieved by both nonoperative and operative treatment methods. (10.1177/23259671221084979)
  • [L2] Mortality was independently associated with the DNA methylation age, and that age was approximately 17 years greater than chronological age in the mortality cohort. (10.2106/jbjs.23.01468)

See Also

References

[1] Extending conceptual frameworks: life course epidemiology for the study of back pain. BMC Musculoskeletal Disorders. 2010. DOI: 10.1186/1471-2474-11-23

[2] Survivorship and prognostic factors for pleomorphic liposarcoma: a population-based study. Journal of Orthopaedic Surgery and Research. 2021. DOI: 10.1186/s13018-021-02327-3

[3] Elbow Dislocations in a Canadian Metropolitan Health Region: A 3-Year Population-Based Incidence Study. Shoulder & Elbow. 2010. DOI: 10.1111/j.1758-5740.2010.00084.x

[4] Prevalence of Morphological Variations Associated With Femoroacetabular Impingement According to Age and Sex: A Study of 1878 Asymptomatic Hips in Nonprofessional Athletes. Orthopaedic Journal of Sports Medicine. 2021. DOI: 10.1177/2325967120977892

[5] Epidemiological Trends and Projections of Adolescent Idiopathic Scoliosis Patients Among 118 Thousand Patients. Journal of the American Academy of Orthopaedic Surgeons. 2026. DOI: 10.5435/jaaos-d-25-00893

[6] Life Expectancy After Treatment of Metastatic Bone Disease: An International Trend Analysis. Journal of the American Academy of Orthopaedic Surgeons. 2024. DOI: 10.5435/jaaos-d-23-00332

[7] The North Staffordshire Osteoarthritis Project – NorStOP: Prospective, 3-year study of the epidemiology and management of clinical osteoarthritis in a general population of older adults. BMC Musculoskeletal Disorders. 2004. DOI: 10.1186/1471-2474-5-2

[8] Prevalence and incidence of doctor-diagnosed Dupuytren’s disease: a population-based study. Journal of Hand Surgery (European Volume). 2017. DOI: 10.1177/1753193416687914

[9] Longitudinal associations between incident lumbar spine MRI findings and chronic low back pain or radicular symptoms: retrospective analysis of data from the longitudinal assessment of imaging and disability of the back (LAIDBACK). BMC Musculoskeletal Disorders. 2014. DOI: 10.1186/1471-2474-15-152

[10] Incidence and prevalence of upper-extremity musculoskeletal disorders. A systematic appraisal of the literature. BMC Musculoskeletal Disorders. 2006. DOI: 10.1186/1471-2474-7-7

[11] Prevalence and predictors of persistent pelvic girdle pain 12 years postpartum. BMC Musculoskeletal Disorders. 2017. DOI: 10.1186/s12891-017-1760-5

[12] Congressionally Directed Research Will Improve Outcomes Through Funding Opportunities for Orthopaedics. American Academy of Orthopaedic Surgeon. 2011. DOI: 10.5435/00124635-201102001-00009

[13] Progression of vertebral deformity of prevalent vertebral fractures in the elderly: a population-based study. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07254-y

[14] The Rise of Concussions in the Adolescent Population. Orthopaedic Journal of Sports Medicine. 2016. DOI: 10.1177/2325967116662458

[15] Research perspectives: The 2013 AAOS/ORS research symposium on Bone Quality and Fracture Prevention. Journal of Orthopaedic Research. 2014. DOI: 10.1002/jor.22626

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[19] Management of Patients with Orthopaedic Implants Undergoing Dental Procedures. Journal of the American Academy of Orthopaedic Surgeons. 2017. DOI: 10.5435/jaaos-d-17-00006

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[22] Heterogeneity in health status and the influence of patient characteristics across patients seeking musculoskeletal orthopaedic care – a cross-sectional study. BMC Musculoskeletal Disorders. 2013. DOI: 10.1186/1471-2474-14-83

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[26] Epidemiology of ossification of the spinal ligaments and associated factors in the Chinese population: a cross-sectional study of 2000 consecutive individuals. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2569-1

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[33] Epidemiology of Ankle-Related Basketball Injuries Treated in Emergency Departments During 2014-2023. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/23259671251399846

[34] Incidence Rates of Surgery After Knee MRI: Association According to Referring Physician Type and Patient’s Age and Sex. Orthopaedic Journal of Sports Medicine. 2021. DOI: 10.1177/23259671211052560

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[41] Predictors of health care drop-out in an inception cohort of patients with early onset rheumatoid arthritis. BMC Musculoskeletal Disorders. 2017. DOI: 10.1186/s12891-017-1670-6

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