For more information, contact:Joanne Swanson (847) 384-4035 Swanson@aaos

Todd Schuetz (847) 384-4032 [email protected]

A.J. Wright(847) 384-4034 [email protected]

Poster Exhibit 320For P.M. Release Wed., Feb. 28, 2001Study shows damaged blood vessels cause low back problems

SAN FRANCISCO-- A new study shows that smoking, hypertension and hypercholesterolemia are related to the development of lower back pain and lumbar degenerative disease.

The results of a 53-year-old study, presented at the 68th annual meeting of the American Academy of Orthopaedic Surgeons, support the hypothesis that problems in the lower back are caused by atherosclerotic occlusion of the blood vessels in that area. Smoking, hypertension, and high cholesterol are risk factors for atherosclerosis, or the formation of fatty plaques within the endothelium of arteries.

Researchers at Johns Hopkins University studied 1,337 physicians who graduated from the medical school between 1948 and 1964. Medical data was recorded from 1948 to 2000 based on questionnaires the physicians filled out and the medical records they had sent in each year to Johns Hopkins.

"Those risk factors damage blood vessels by forming collections of fatty deposits underneath their inner lining, which can cause the blockage or occlusion of these blood vessels," said lead author Nicholas U. Ahn, MD, chief resident in the department of orthopaedic surgery at the Johns Hopkins Hospital in Baltimore.

"Because we had the subjects' medical records and answers from self-reported questionnaires over such a long period of time, a 53-year period of time for the oldest patients, we were able to determine if the risk factors, such as smoking or high cholesterol, preceded the development of the disease years later," explained Dr. Ahn. "In this case the disease of interest is lumbar spine pain and deterioration." He noted that the idea for the study was inspired by co-author Paul D. Sponseller, MD, vice chairman of the department of orthopaedic surgery and chief of pediatric orthopaedics at Johns Hopkins.

"To prove a causative association from a long-term prospective study is very powerful because one can show that the cause occurred before the effect as opposed to the other way around," said Dr. Ahn. "When you look at data retrospectively, you cannot demonstrate that the risk factor occurred before the disease, which makes the association and the supposed causality less convincing."

According to the study, development of low back pain was significantly associated with smoking history and hypertension. Development of lumbar spondylosis was significantly associated with smoking history, and hypertension and high cholesterol.

Additional co-authors of the study with Dr. Ahn and Dr. Sponseller include Uri M. Ahn, MD, attending spine surgeon at the New Hampshire Spine Institute in Bedford, N.H.; Leelakrishna Nallamshetty, a third year medical student at Jefferson Medical College in Philadelphia; Peter S. Rose, MD, a fourth year medical student at the Johns Hopkins University School of Medicine; and Jacob M. Buchowski, MD, an intern at the Johns Hopkins Hospital.

The 25,500-member American Academy of Orthopaedic Surgeons ( is a not-for-profit organization that provides education programs for orthopaedic surgeons, allied health professionals and the public.

An advocate for improved patient care, the Academy is participating in the Bone and Joint Decade (, the global initiative in the years 2000-2010 to raise awareness of musculoskeletal health, stimulate research and improve people's quality of life. The Academy's annual meeting is being held February 28-March 4, 2001 at the Moscone Convention Center, San Francisco.

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