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
After the clinical exam, a working differential diagnosis can usually be established. Laboratory and radiographic studies are used to complete the workup and confirm a diagnosis. In evaluating a child with back pain, it is critical that the child not be compared with adults who present with back pain. Overuse and lumbar strain should be diagnoses of inclusion after all other causes for back pain have been excluded. In some instances, a diagnosis cannot be established despite a thorough evaluation. In these situations it is appropriate to reexamine the child at specific intervals to evaluate any changes in symptoms. On occasion, time helps clarify the picture and makes it possible to establish a firm diagnosis. lt can be assumed that serious problems do not resolve spontaneously.
Turner et a1(36) have shown that more than 50% of children age 15 or younger with non-traumatic back complaints were found to have a diagnosis specific for the back symptoms. King and Tufel(20) reported on a prospective study of 54 children with back pain presenting to a tertiary children's spine clinic at a regional children's hospital. None of the patients included in the study had a previous diagnosis established at the time of presentation. At the conclusion of their evaluation at the center, thirty-four of the 54 patients had a diagnosis believed to be the cause for the presenting symptoms. Both the Turner and King studies were done at orthopedic referral centers. The incidence of a positive diagnosis may be less in a primary care setting, but in specialized centers, back pain is frequently correlated with a physical problem. King's study was a prospective study, and no patient was included in the series if a confirmed diagnosis was available at the time of the center's clinical evaluation. It appears that in a referral center one might expect to find a high incidence of positive diagnoses which correlate with the original presenting symptoms. The most alarming finding in both the Turner (36) and the King (18-20) series were the number of tumor cases found as the cause of symptoms. In King's series, (18) 6 of 54 patients (11%) and in Turner's series, (36) 4 of 61 (6%) patients were found to have a tumor around the spine.
The age at presentation can be useful in helping to establish a differential diagnosis. In the author's experience, children younger than age 10 are more likely to have diskitis or a tumor as a cause of their symptoms. In patients older than 10, the symptoms seem more likely to be from spondylolysis, spondylolisthesis, or Scheuermann's kyphosis. It is possible, however, to see infection, tumors, disk herniation, and vertebral end plate fractures in this age group as well.