Imaging of Back Pain in Children

Abstract

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.

Effects of an educational back care program on Brazilian schoolchildren's knowledge regarding back pain prevention

“…Question 7 implied a percentage calculation that may have contributed to the higher proportion of incorrect answers, as the students have difficulty with mathematics 37 . Questions related to handling of school materials (5,6,8,9, and 10) and to sitting posture (3 and 4) showed the highest decrease in incorrect answers and the highest rate of correct answers. These questions included subjects close to the students' reality and illustrations that enabled them to understand better.…”

“…This variation can be attributed to the population and the diagnostic criteria considered [6][7][8] . During school years, children spend one third of their waking hours at school 9 , an environment that can expose them to ergonomic risk factors including carrying heavy backpacks, sitting postures for prolonged periods, and inadequate furniture [10][11][12][13] .…”

Back pain during growth

“…Occult spinal cord abnormalities may lead to unexplained back pain, atypical scoliosis (thoracic left convex), gait abnormality, limb pain or weakness and -above all -rigid or recurrent foot deformity [40]. Red flags for diagnosis other than muscular pain, Scheuermann disease, spondylolysis and scoliosis are age of the patient <5 years, acute trauma, functional limitation for activities of daily living, irradiating pain, loss of weight, duration >4 weeks, history of tumour, exposition to tuberculosis, night pain and fever [41]. Tumours of the spine and spinal cord are rare and only occasionally visible on conventional X-rays ( fig.…”

Review for the generalist: evaluation of low back pain in children and adolescents

“…CT is useful in further characterizing lesions identified on bone scan, including fractures, spondylolysis and tumors [11]. …”

“…Weakness in a myotomal distribution, numbness in a dermatomal distribution and diminished reflexes are not common in adolescents with disc herniation. Investigations include radiographs and MRI of the lumbar spine [11]. Careful inspection is required to differentiate between spondylolysis with nerve root impingement or disc herniation with nerve root impingement.…”