DISORDERS OF THE PEDIATRIC AND ADOLESCENT SPINE
Back Pain in Children
Howard A. King, MDPage: 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11
Magnetic Resonance Imaging
The use of MR imaging has had a huge impact on the ability to diagnose problems around the spine and is invaluable in diagnosing spinal cord tumors, syringomyelia, tethered cords, disk herniations, and other neural pathology They have also proven to be useful in evaluating diskitis and some bone lesions.
Tertti et a1(35) have cautioned against overinterpreting MR imaging studies. Tertti et al studied two groups of adolescents, one with back pain and one without symptoms. The study showed that 38% of the patients with back pain had disk degeneration and 26% of the asymptornatic patients had disk degeneration by age 15.15 The study concluded that MR imaging evidence of changes in the disk are common by age 15 even in asymptornatic individuals.
MR imaging scans should not be used as a shotgun diagnostic tool. They are costly and in the younger child frequently necessitate deep sedation or general anesthesia. Frequently the author sees a child referred for back pain by another practitioner in whom no radiographs were obtained but a full MR imaging study has been done. MR imaging studies are wonderful diagnostic tools but should be used in the appropriate clinical setting.
LABORATORY EVALUATION
Although not routine, laboratory studies can be valuable when looking for specific medical problems such as in cases in which infection, rheurnatologic disease, lymphoma, or leukemia are in the differential diagnoses. Complete blood count, sedimentation rate, and urinalysis are useful for screening. HLAB27, rheumatoid factor, antinuclear antibody, and Lymetiters can be obtained in cases in which rheurnatologic problems are suspected.
DIFFERENTIAL DIAGNOSIS
Bunnell7 separated back pain into four categories (Table 1):
- Mechanical disorders
- Developmental disorders
- Inflammatory disorders
- Neoplastic disorders