Diagnostic Modalities for the Evaluation of Pediatric Back Pain

Bhatia, Nitin; Chow, Gregory H.; Timon, Stephen; Watts, Hugh G.

doi:10.1097/bpo.0b013e3181651bc8

Cited by 86 publications

(72 citation statements)

References 14 publications

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“…16 For example, while some articles refer to back pain in general 11,15,17,18 others refer exclusively to low back pain 4,5,19 or to nonspecific back pain. 20,21 Back pain in children is often the manifestation of a benign process; in some cases, however, it may suggest a serious pathology such as a neoplasm or an infectious process.…”

Section: Epidemiologymentioning

confidence: 99%

“…Unfortunately, organic pathology (benign or malignant) is not always identifiable; this problem, in turn, frequently leads to extensive diagnostic work-ups in children described as having nonspecific or mechanical back pain. 17,19 In a recent prospective study, Bhatia et al 17 examined the rate of pediatric back pain diagnosed and the value of the various tests used in making diagnoses. In this study, 78% of patients had no definitive final diagnosis, including those with disorders that might have been treatable but were not identified.…”

Section: Epidemiologymentioning

confidence: 99%

“…Various algorithms have been used and are proposed for routine clinical practice. 11,15,17,19 Imaging evaluation is reserved for those patients with symptoms and signs suggesting an underlying pathology. Conventional radiographs are used as the initial diagnostic screening test.…”

Section: Imaging Evaluationmentioning

confidence: 99%

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Imaging of Back Pain in Children

Rodriguez¹,

Poussaint²

2009

AJNR Am J Neuroradiol

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SUMMARY:While back pain presents less frequently in children than in adults, it still poses a significant clinical challenge with respect to making a firm diagnosis and developing an effective treatment plan. When children have back pain and medical attention is sought, an underlying pathology is usually suspected. Pediatric patients are evaluated, first, with a complete clinical history and examination and, second, by an imaging work-up that is based on initial findings, including the child's age and size, signs and symptoms, and suspected etiology. This article describes 1) the epidemiology of back pain in children, 2) the imaging work-up used, and 3) the correlation of imaging findings with disease entities that may cause back pain in the pediatric patient. The list of diseases giving rise to back pain is not meant to be exhaustive but rather reflective of the most commonly identified pathologies and disorders among young children and adolescents, from athletic injuries to lethal cancers.ABBREVIATIONS: ALARA ϭ as low as reasonably achievable; ESR ϭ erythrocyte sedimentation rate; FSE ϭ fast spin-echo; 18 F ϭ fluorine 18; LCH ϭ Langerhans cell histiocytosis; LDH ϭ lactate dehydrogenase; MBP ϭ mechanical back pain; PET ϭ positron-emission tomography; RFA ϭ radio-frequency ablation, SPECT ϭ single-photon emission computed tomography; STIR ϭ short tau inversion recovery; 99m Tc-MDP ϭ technetium 99m methylene diphosphonate; WHO ϭ World Health Organization B ack pain in children presents less frequently than in adults. The incidence of back pain in adults has been estimated to be as high as 60%-80% 1 ; the actual incidence of back pain in children, however, is unknown. Back pain in children presenting to the emergency department was originally thought to be an uncommon complaint, 2 reflecting significant underlying pathology compared with adults. Although recent studies have shown an increased prevalence of back pain in children, [3][4][5][6][7] relatively few patients receive medical attention.

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Section: Epidemiologymentioning

confidence: 99%

Section: Epidemiologymentioning

confidence: 99%

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Imaging of Back Pain in Children

Rodriguez¹,

Poussaint²

2009

AJNR Am J Neuroradiol

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“…However, a specific generator of low back pain is not always found, which makes diagnosis and treatment more difficult (11). One study concluded that exhaustive diagnostic protocols may not be necessary in pediatric patients with low back pain because their symptoms do not permit a definitive diagnosis (10). However, although most cases are self-limiting, some young athletes have persistent symptoms (6).…”

Section: Introductionmentioning

confidence: 99%

“…Diagnostic modalities available for evaluation of back pain in children include plain radiograph, computed tomography (CT), magnetic resonance imaging (MRI), single -photon emission CT, and laboratory investigations (10). However, a specific generator of low back pain is not always found, which makes diagnosis and treatment more difficult (11).…”

Section: Introductionmentioning

confidence: 99%

Accurate diagnosis of chronic low back pain in a high-level college athlete: a case report

et al. 2017

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: A 21-year-old woman who was high-level college softball player presented with a 6-month history of low back pain that had been treated unsuccessfully by medication at local clinics. There was tenderness in the left paravertebral muscle at the lower lumbar level. X-ray and computed tomography revealed congenital scoliosis and an L6 hemivertebra. Short tau inversion recovery magnetic resonance imaging showed a fluid collection at the left L6-S1 facet joint. We performed a diagnostic facet injection, consisting of 1% % lidocaine and steroids, that was infiltrated into the left facet joint at L6-S1. Her persistent low back pain disappeared immediately after the facet block. We diagnosed left-sided facet arthritis at L6-S1. Due to her multiple congenital anomalies, excessive loading occurred at the facet joint. Therefore, we opted for conservative management, including mobilization of the thoracic spine and stretching of hamstrings and quadriceps. This case report underscores the importance of accurate diagnosis of low back pain and of the diagnostic utility of short tau inversion recovery magnetic resonance imaging and lumbar facet block in young athletes with chronic spinal pain.

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Musculoskeletal Low Back Pain in School-aged Children

2017

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ow back pain (LBP) in school-aged children is a common occurrence; nevertheless, it is often underappreciated. 1 The prevalence of LBP rises with age: 1% at age 7 years, 6% at age 10 years, and 18% at ages 14 to 16 years. 2 By age 18 years, the lifetime prevalence rates of LBP approach those documented in adults, with an estimated yearly prevalence of 20% and a lifetime prevalence of 75%. 3 More than 7% of adolescents experiencing LBP will seek medical attention. 1 The effect of LBP on this population can be considerable and may significantly restrict instrumental activities of daily living for this population, such as attendance at school and gym or sports participation. 4 Low back pain in this age group is a significant risk factor for developing LBP as an adult. 5 Several potential risk factors for developing LBP in schoolaged children have been investigated. The prevalence of LBP correlates with participation in sports and level of competition. 4,6,7 There is a U-shaped association between physical activity and the incidence of LBP in school-aged children, with both low and high levels of physical activity associated with a higher risk. 8,9 Female sex, growth acceleration, adverse psychosocial factors, increasing age, previous back injury, and family history of LBP are all potential risk factors for school-aged children to develop LBP. 9-12 Although there has been concern about a potential association of LBP and backpacks, the evidence pointing to use of backpacks as a risk factor is weak. 9 No single risk factor for a first episode of LBP in school-aged children has been definitively validated (level of evidence, 1). 13 Historically, it has been taught that most LBP in school-aged children has an identifiable diagnosis. More recent research has challenged this thinking. A high-quality prospective study of 73 pediatric patients with LBP (level of evidence, 2) followed up for 2 years found that nearly 80% had no definitive diagnosis. 14 Most cases of LBP in school-aged children are nonspecific and self-limiting. 15,16 Discussion and Observations Relevant AnatomyPediatricians need a basic but solid understanding of the anatomy of the lumbosacral spine to provide effective care to school-aged children with LBP. The lumbar spine is composed of 5 vertebrae IMPORTANCE Low back pain (LBP) in children and adolescents is a common problem. The differential diagnosis of LBP in this population is broad and different from that seen in the adult population. Most causes of LBP are musculoskeletal and benign in their clinical course. Clinicians should have an understanding of the relevant anatomy and the most commonly encountered etiologic factors of LBP in children and adolescents to provide effective care.OBSERVATIONS Low back pain is rarely seen in youth before they reach school age. Subsequently, rates of LBP rise until age 18 years, at which age the prevalence of LBP is similar to that in adults. The differential diagnosis of LBP in this population is broad, and individual etiologic factors are most often associated wit...

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Diagnostic Modalities for the Evaluation of Pediatric Back Pain

Abstract: Prospective study; Level 2 clinical evidence.

Cited by 86 publications

References 14 publications

Imaging of Back Pain in Children

Imaging of Back Pain in Children

Accurate diagnosis of chronic low back pain in a high-level college athlete: a case report

Musculoskeletal Low Back Pain in School-aged Children

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