Back Pain, Pediatric



Back Pain, Pediatric


Kevin R. Moore, MD



DIFFERENTIAL DIAGNOSIS


Common



  • Scoliosis



    • Scoliosis, Idiopathic


    • Scoliosis, Neuromuscular


    • Scoliosis, Congenital


  • Trauma



    • Fracture


    • Spinal Muscle Injury, Traumatic


  • Syringomyelia


  • Spondylolysis


  • Scheuermann Disease


Less Common



  • Stenosis, Congenital Spinal


  • Guillain-Barré Syndrome


  • Neoplasm



    • Leukemia


    • Neuroblastic Tumor


    • Ewing Sarcoma


    • Ependymoma, Myxopapillary, Spinal Cord


    • Metastases, CSF Disseminated


    • Metastases, Hematogenous


    • Osteoid Osteoma


    • Langerhans Cell Histiocytosis


  • Osteomyelitis



    • Osteomyelitis, Granulomatous


    • Osteomyelitis, Pyogenic


Rare but Important



  • Intervertebral Disc Herniation


  • Acute Transverse Myelitis, Idiopathic


  • Secondary Acute Transverse Myelitis


ESSENTIAL INFORMATION


Key Differential Diagnosis Issues



  • Clinical history, physical examination, and appropriate laboratory investigations constrains differential considerations


Helpful Clues for Common Diagnoses



  • Scoliosis



    • Scoliosis, Idiopathic



      • Usually sigmoid S-shaped


      • Pelvic tilt ⇒ limb-length discrepancy


      • No vertebral segmentation anomalies


    • Scoliosis, Neuromuscular



      • C-shaped curvature common


      • Baclofen infusion device clue if present


    • Scoliosis, Congenital



      • Vertebral segmentation and formation anomalies


      • Rib fusions, pedicular bars ⇒ more likely progressive curvature


  • Trauma



    • Fracture



      • Similar criteria to adults


    • Spinal Muscle Injury, Traumatic



      • MR or CT best for diagnosis – T2WI FS MR or STIR MR most helpful for diagnosis, determining extent


  • Syringomyelia



    • Chiari 1 malformation common association in pediatric patients


    • Always consider traumatic, neoplastic causes



      • Administer contrast if tumor suspected or nodularity detected


  • Spondylolysis



    • Unilateral or bilateral; may not see osseous break (stress reaction)


    • Oblique plain radiographs, MR show osseous defects well


    • Bone scintigraphy sensitive for detecting stress reaction prior to pars fracture


  • Scheuermann Disease



    • Most common in adolescent age group


    • Diagnostic criteria include anterior wedging, kyphosis, endplate irregularity


    • May see significant kyphosis ± scoliosis


Helpful Clues for Less Common Diagnoses

Tags:
Aug 7, 2016 | Posted by in NEUROLOGY | Comments Off on Back Pain, Pediatric

Full access? Get Clinical Tree
Get Clinical Tree app for offline access