Musculoskeletal conditions are a major burden on individuals, health systems, and social care systems, with indirect costs being predominant. This burden has been recognized by the United Nations and WHO, by endorsing the Bone and Joint Decade 2000-2010. This paper describes the burden of four major musculoskeletal conditions: osteoarthritis, rheumatoid arthritis, osteoporosis, and low back pain. Osteoarthritis, which is characterized by loss of joint cartilage that leads to pain and loss of function primarily in the knees and hips, affects 9.6% of men and 18% of women aged > 60 years. Increases in life expectancy and ageing populations are expected to make osteoarthritis the fourth leading cause of disability by the year 2020. Joint replacement surgery, where available, provides effective relief. Rheumatoid arthritis is an inflammatory condition that usually affects multiple joints. It affects 0.3-1.0% of the general population and is more prevalent among women and in developed countries. Persistent inflammation leads to joint destruction, but the disease can be controlled with drugs. The incidence may be on the decline, but the increase in the number of older people in some regions makes it difficult to estimate future prevalence. Osteoporosis, which is characterized by low bone mass and microarchitectural deterioration, is a major risk factor for fractures of the hip, vertebrae, and distal forearm. Hip fracture is the most detrimental fracture, being associated with 20% mortality and 50% permanent loss in function. Low back pain is the most prevalent of musculoskeletal conditions; it affects nearly everyone at some point in time and about 4-33% of the population at any given point. Cultural factors greatly influence the prevalence and prognosis of low back pain.

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Burden of major musculoskeletal conditions

Background: We studied the incidence, prevalence, and radiographic progression of symptomatic adjacent-segment disease, which we defined as the development of new radiculopathy or myelopathy referable to a motion segment adjacent to the site of a previous anterior arthrodesis of the cervical spine. Methods: A consecutive series of 374 patients who had a total of 409 anterior cervical arthrodeses for the treatment of cervical spondylosis with radiculopathy or myelopathy, or both, were followed for a maximum of twenty-one years after the operation. The annual incidence of symptomatic adjacent-segment disease was defined as the percentage of patients who had been disease-free at the start of a given year of follow-up in whom new disease developed during that year. The prevalence was defined as the percentage of all patients in whom symptomatic adjacent-segment disease developed within a given period of follow-up. The natural history of the disease was predicted with use of a Kaplan-Meier survivorship analysis. The hypothesis that new disease at an adjacent level is more likely to develop following a multilevel arthrodesis than it is following a single-level arthrodesis was tested with logistic regression. Results: Symptomatic adjacent-segment disease occurred at a relatively constant incidence of 2.9 percent per year (range, 0.0 to 4.8 percent per year) during the ten years after the operation. Survivorship analysis predicted that 25.6 percent of the patients (95 percent confidence interval, 20 to 32 percent) who had an anterior cervical arthrodesis would have new disease at an adjacent level within ten years after the operation. There were highly significant differences among the motion segments with regard to the likelihood of symptomatic adjacent-segment disease (p < 0.0001); the greatest risk was at the interspaces between the fifth and sixth and between the sixth and seventh cervical vertebrae. Contrary to our hypothesis, we found that the risk of new disease at an adjacent level was significantly lower following a multilevel arthrodesis than it was following a single-level arthrodesis (p < 0.001). More than two-thirds of all patients in whom the new disease developed had failure of nonoperative management and needed additional operative procedures. Conclusions: Symptomatic adjacent-segment disease may affect more than one-fourth of all patients within ten years after an anterior cervical arthrodesis. A single-level arthrodesis involving the fifth or sixth cervical vertebra and preexisting radiographic evidence of degeneration at adjacent levels appear to be the greatest risk factors for new disease. Therefore, we believe that all degenerated segments causing radiculopathy or myelopathy should be included in an anterior cervical arthrodesis. Although our findings suggest that symptomatic adjacent-segment disease is the result of progressive spondylosis, patients should be informed of the substantial possibility that new disease will develop at an adjacent level over the long term.

/pdf/radiculopathy-and-myelopathy-at-segments-adjacent-to-the-2iuest9mmt.pdf

Radiculopathy and Myelopathy at Segments Adjacent to the Site of a Previous Anterior Cervical Arthrodesis

https://onlinelibrary.wiley.com/doi/pdf/10.1002/1529-0131%28199808%2941%3A8%3C1343%3A%3AAID-ART3%3E3.0.CO%3B2-9

An update on the epidemiology of knee and hip osteoarthritis with a view to prevention

https://www.oarsijournal.com/article/S1063-4584(05)00112-3/pdf

A meta-analysis of sex differences prevalence, incidence and severity of osteoarthritis

We evaluated the results of the Robinson method of anterior cervical discectomy and arthrodesis with use of autogenous iliac-crest bone graft, at one to four levels, in 122 patients who had cervical radiculopathy. A one-level procedure was done in sixty-two of the 122 patients; a two-level procedure, in forty-eight; a three-level procedure, in eleven; and a four-level procedure, in one. The average duration of clinical and roentgenographic follow-up was six years (range, two to fifteen years). The average age was fifty years (range, twenty-five to seventy-eight years). Preoperatively, 118 patients had pain in the arm, fifty-five had weakness of one or more motor roots, and seventy-seven had sensory loss. At the time of follow-up, eighty-one patients had no pain in the neck, twenty-six had mild pain in the neck, nine had moderate pain in the neck, four had mild radicular pain, and two had a combination of mild radicular pain and moderate pain in the neck. One hundred and eight patients had no functional impairment, and fourteen had a slight limitation of function during the activities of daily living. Nine of eleven patients who had symptoms related to a change at one level cephalad or caudad to the site of a previous arthrodesis had another operative procedure. Lateral roentgenograms of the cervical spine, made in flexion and extension, showed a pseudarthrosis at twenty-four of 195 operatively treated segments. Sixteen of the patients who had a pseudarthrosis were symptomatic, but only four had sufficient pain to warrant revision. The risk of pseudarthrosis was significantly greater after a multiple-level arthrodesis than after a single-level arthrodesis (p < 0.01). At the time of the most recent follow-up, fifty-three of the fifty-five patients who had had a motor deficit had had a complete recovery, and the two remaining patients had had a partial recovery. Seventy-one of the seventy-seven patients who had had a sensory loss had regained sensation. None of the patients had an increased neurological deficit postoperatively. Our results suggest that the Robinson anterior cervical discectomy and arthrodesis with an autogenous iliac-crest bone graft for cervical radiculopathy is a safe procedure that can relieve pain and lead to resolution of neurological deficits in a high percentage of patients.

Robinson Anterior Cervical Discectomy and Arthrodesis for Cervical Radiculopathy. Long-Term Follow-up of One Hundred and Twenty-two Patients.

This study of osteo-arthrosis, or degenerative joint disease, is based on the same survey material as the corresponding paper on rheumatoid arthritis (Kellgren and Lawrence, 1956). A one-in-ten random sample of the population aged 55-64 years in the Lancashire town of Leigh was studied clinically, radiologically, and serologically for all forms of arthritis. After a detailed clinical examination of the joints, routine x rays were taken of the hands, feet, pelvis, knees, and cervical and lumbar spine, and a blood sample was taken for the sheep cell agglutination test (SCAT). The clinical and radiological part of the survey was 79 per cent. complete. In a previous survey of rheumatic complaints made in the town of Leigh in 1949-50, osteo-arthrosis was diagnosed on clinical grounds more frequently than any other form of rheumatism (Kellgren, Lawrence, and Aitken-Swan, 1953). The prevalence of complaints attributable to osteo-arthrosis was exceptionally high in females over 50 years of age, and in this sex was more often polyarticular and was less closely associated with trauma or occupation than in males. A separate study of patients seen at the University Rheumatism Clinic had shown that women frequently suffer from a polyarticular form of osteo-arthrosis which has a distinct symptomatology, course, and pattern of joint involvement. This condition has been described as \"primary generalized osteo-arthritis\" (Kellgren and Moore, 1952). The present study was designed to obtain more precise information about this condition, and to investigate causative factors in osteo-arthrosis in general. For details of sampling and for the method of conducting the survey, the paper on rheumatoid arthritis should be consulted. At the clinical examination all persons seen were given a grading for rheumatoid arthritis and for local and generalized osteo-arthrosis. The x rays were later read by two observers in consultation. Problems of observer

https://ard.bmj.com/content/annrheumdis/17/4/388.full.pdf

J. H. Kellgren

Papers

Osteo-arthrosis and disk degeneration in an urban population.