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PLoS One. 2018 Jun 1;13(6):e0197987. doi: 10.1371/journal.pone.0197987. eCollection 2018.

A scoping review of biopsychosocial risk factors and co-morbidities for common spinal disorders.

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Qualcomm Health Center, Stanford Health Care, San Diego, California, United States of America.
Publications Department, National University of Health Sciences, Lombard, Illinois, United States of America.
Department of Neurology, University of California, Irvine, California, United States of America.
Department of Epidemiology, School of Public Health, University of California, Los Angeles, California, United States of America.
World Spine Care, Santa Ana, California, United States of America.
Emergency Medicine, Carlsbad, California, United States of America.
Rehabilitation Care Line, Physical Medicine and Rehabilitation, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, United States of America.
College of Rehabilitative Sciences, Doctor of Physical Therapy Program, University of St. Augustine for Health Sciences, San Marcos, California, United States of America.
National School of Occupational Medicine, Carlos III Institute of Health, Complutense University of Madrid, Madrid, Spain.
Department of Orthopaedics, Ganga Hospital, Coimbatore, Tamil Nadu, India.
Section of Physical Medicine and Rehabilitation and Department of Orthopaedic Surgery, Stanford University, Redwood City, California, United States of America.
Office of Public Health Studies, University of Hawai`i, Mānoa, Honolulu, Hawaii, United States of America.
UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology, Toronto, Ontario, Canada.
Department of Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
Department of Orthopedic Surgery, New York University, New York, New York, United States of America.
Department of Environmental Medicine, New York University, New York, New York, United States of America.



The purpose of this review was to identify risk factors, prognostic factors, and comorbidities associated with common spinal disorders.


A scoping review of the literature of common spinal disorders was performed through September 2016. To identify search terms, we developed 3 terminology groups for case definitions: 1) spinal pain of unknown origin, 2) spinal syndromes, and 3) spinal pathology. We used a comprehensive strategy to search PubMed for meta-analyses and systematic reviews of case-control studies, cohort studies, and randomized controlled trials for risk and prognostic factors and cross-sectional studies describing associations and comorbidities.


Of 3,453 candidate papers, 145 met study criteria and were included in this review. Risk factors were reported for group 1: non-specific low back pain (smoking, overweight/obesity, negative recovery expectations), non-specific neck pain (high job demands, monotonous work); group 2: degenerative spinal disease (workers' compensation claim, degenerative scoliosis), and group 3: spinal tuberculosis (age, imprisonment, previous history of tuberculosis), spinal cord injury (age, accidental injury), vertebral fracture from osteoporosis (type 1 diabetes, certain medications, smoking), and neural tube defects (folic acid deficit, anti-convulsant medications, chlorine, influenza, maternal obesity). A range of comorbidities was identified for spinal disorders.


Many associated factors for common spinal disorders identified in this study are modifiable. The most common spinal disorders are co-morbid with general health conditions, but there is a lack of clarity in the literature differentiating which conditions are merely comorbid versus ones that are risk factors. Modifiable risk factors present opportunities for policy, research, and public health prevention efforts on both the individual patient and community levels. Further research into prevention interventions for spinal disorders is needed to address this gap in the literature.

[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

BNG receives speaker fees and travel reimbursement, NCMIC Speakers’ Bureau; book royalties, McGraw-Hill; is secretary and chief financial officer of Brighthall Inc and is a stockholder. CDJ is a member of the NCMIC Board of Directors, however she, nor this board, make funding decisions for the NCMIC Foundation; book royalties, McGraw-Hill; is president of Brighthall Inc and is a stockholder. Brighthall, Inc provided funding only for open access publishing fees for PLOS ONE and had no other financial participation in this study. BNG and CDJ received no compensation from Brighthall, Inc for participation in this study, as they were volunteers for the Globa l Spine Care Initiative. SH is president, World Spine Care; Clinical advisory board and stock holder, Palladian Health; advisory board,; book royalties, McGraw Hill; travel expense reimbursement, Canadian Memorial Chiropractic College Board. MS is board of directors, North American Spine Society; board of directors, Foundation for PM&R; board of directors, Spine Intervention Society; deputy editor, The Spine Journal; scientific advisor, NuSpine; consultant, State Farm. This does not alter the authors’ adherence to PLOS ONE policies on sharing data and materials. The following authors have no potential conflicts of interest to declare: EG, MBC, EJK, JMC, SR, ELH, KR, HY, MN.

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