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

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


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

Methods: 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.

Results: 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.

Conclusion: 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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Comorbidity*
  • Humans
  • Risk Factors
  • Spinal Diseases / epidemiology*
  • Spinal Diseases / psychology*

Grants and funding

The Global Spine Care Initiative (GSCI) was funded by grants from the Skoll Foundation (www.skoll.org) and NCMIC Foundation (www.ncmicfoundation.org) (SH). World Spine Care provided financial management for the GSCI project. The grantors had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Open access funding for this study provided by Brighthall, Inc. BNG and CDJ are officers of Brighthall.