Younger children were more likely to present with renal stones, while older children had more ureteral stones. Overall children 10 years old or younger are as likely to pass stones as older children. Renal stones are more likely to be successfully managed expectantly in younger children. Metabolic abnormalities and stone recurrences are observed at similar rates between younger and older children.

ObjectivesNeck pain commonly accompanies recurrent headaches such as migraine, tension-type and cervicogenic headache. Neck pain may be part of the headache symptom complex or a local source. Patients commonly seek neck treatment to alleviate headache, but this is only indicated when cervical musculoskeletal dysfunction is the source of pain. Clinical presentation of reduced cervical extension, painful cervical joint dysfunction and impaired muscle function collectively has been shown to identify cervicogenic headache among patients with recurrent headaches. The pattern’s validity has not been tested against the ‘gold standard’ of controlled diagnostic blocks. This study assessed the validity of this pattern of cervical musculoskeletal signs to identify a cervical source of headache and neck pain, against controlled diagnostic blocks, in patients with headache and neck pain.DesignProspective concurrent validity study that employed a diagnostic model building approach to analysis.SettingHospital-based multidisciplinary outpatient clinic in Joliet, Illinois.ParticipantsA convenience sample of participants who presented to a headache clinic with recurrent headaches associated with neck pain. Sixty participants were enrolled and thirty were included in the analysis.Outcome measuresParticipants underwent a clinical examination consisting of relevant tests of cervical musculoskeletal dysfunction. Controlled diagnostic blocks of C2/C3–C3/C4 established a cervical source of neck pain. Penalised logistic regression identified clinical signs to be included in a diagnostic model that best predicted participants’ responses to diagnostic blocks.ResultsTen of thirty participants responded to diagnostic blocks. The full pattern of cervical musculoskeletal signs best predicted participants’ responses (expected prediction error = 0.57) and accounted for 65% of the variance in responses.ConclusionsThis study confirmed the validity of the musculoskeletal pattern to identify a cervical source of headache and neck pain. Adopting this criterion pattern may strengthen cervicogenic headache diagnosis and inform differential diagnosis of neck pain accompanying migraine and tension-type headache.

Spinal cord stimulation is a treatment modality used to treat various chronic pain conditions, including complex regional pain syndrome (CRPS). We present a case in which spinal cord stimulation was used for the treatment of lower extremity CRPS in a patient with ankylosing spondylitis. Preoperative imaging demonstrated fusion of the lumbothoracic spine with obliteration of the interlaminar spaces. The sacral hiatus remained open and was used to access the epidural space, facilitating the placement of 2 thoracic epidural electrodes. The resulting stimulation controlled not only the patient's lower extremity CRPS pain but also alleviated his chronic axial pain secondary to ankylosing spondylitis.