Persistent or severe back pain and stiffness are ominous symptoms requiring prompt attention

Abstract

Children with severe or persistent back pain and stiffness have a wide variety of underlying causes. The possibility of underlying spinal cord compression should always be considered in children with this presentation. If the diagnosis is not obvious, MRI scan of the spine should be arranged without delay.

Back pain and spinal cord compression: An uncommon presentation of childhood acute myeloid leukemia

“…Irritability, unusual posture or stiffness, and gait abnormality may present as surrogates of back pain, particularly in young children [7,25]. Spinal cord pathology should also be considered in the presence of abdominal pain, severe constipation, and scoliosis [7,8,25]. In the reported case, pain was persistent and progressive, but of relatively short duration.…”

“…Children who present with severe or persistent back pain and stiffness often have an underlying organic cause, albeit with a large differential diagnosis, that includes mechanical, infectious/inflammatory and neoplastic causes [7]. While back pain is a common complaint in children with known cancer, back pain as a presenting symptom of childhood malignancy is less frequent.…”

“…The delayed recognition of tumor as the underlying etiology of back pain in this case elucidates the challenging nature of diagnosis and management of children with back pain. Irritability, unusual posture or stiffness, and gait abnormality may present as surrogates of back pain, particularly in young children [7,25]. Spinal cord pathology should also be considered in the presence of abdominal pain, severe constipation, and scoliosis [7,8,25].…”

“…Other notable features include the thoracic location and rapid evolution of spinal cord compression despite lack of association with other warning symptoms or signs. Such rapid progression to irreversible paraplegia may occur over a period of hours, likely secondary to increased pressure within the spinal canal leading to sudden vascular occlusion and spinal infarction followed by myelomalacia [7,8].…”

A 12-year-old Girl with Sudden Onset of Numbness and Tingling Feet

“…One-half of these patients will have a serious and or-ganic cause. 4,[9][10][11] Back and neck pain, coupled with neurological symptoms, will have a predictive value of positive fi ndings of 100%. 12 Review of the literature summarizes prevalence of and the most common symptoms as back pain and/or radicular pain (100%), paresis of one or both legs (83%), sensory disturbances, and bladder and bowel dysfunction.…”