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Abstract
Back pain is common, in up to 30% of children, increasing with age. Eighty percent is benign, mechanical type, improving within 2 weeks of conservative care. Required for those not improving is in-depth evaluation, including MRI, laboratory, and peer consultations. Spondylolysis and spondylolisthesis comprise almost 10% of pediatric back pain, often caused by lumbar hyperextension activities and treated conservatively in most cases. Osteoid osteomas and osteoblastomas constitute the most common benign spinal tumors in childhood. Aggressive and malignant tumors of the spine are rare but when present require tertiary care referral and a comprehensive oncology team for optimal life-sustaining outcomes.
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Affiliation(s)
- Kevin P Murphy
- Department of Physical Medicine and Rehabilitation, Sanford Health Systems, Bismarck North Dakota and Northern Minnesota, Northland Pediatric Rehabilitation Medicine LLC, 4710 Matterhorn Circle #309, Duluth, MN 55811, USA.
| | - Cristina Sanders
- Pediatric Rehabilitation Medicine, Monument Health Department Neurology and Rehabilitation, Monument Health System, 677 Cathedral Drive, Suite 240, Rapid City, SD 57701, USA
| | - Amy E Rabatin
- Division of Pediatric Rehabilitation Medicine, Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA; Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
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ERDOGAN B, KOLUTEK AY B. Investigation of Spinal Magnetic Resonance Imaging Results of Pediatric Patients Presenting with Low Back Pain. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2022. [DOI: 10.17517/ksutfd.1156487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective: Low back pain in pediatric patients can be severe in terms of its consequences and should be investigated. In this study, the etiology of pediatric low back pain was examined, and it was evaluated whether there was a relationship between age and gender.
Material and Methods: In this study, 228 patients under 18 who applied to Şanlıurfa Training and Research Hospital Physical Medicine and Rehabilitation and Brain and Nerve Surgery polyclinics complained of low back pain and underwent spinal Magnetic Resonance Imaging (MRI) in 2021 were analyzed retrospectively.
Results: The ages of 228 patients included in our study ranged from 4 to 18 years, with a mean age of 12.8±2.5. 54.8% of the cases were male (n=125), 45.2% (n=103) were female. While MRI findings were not observed in 92 cases, MRI findings were found in 136 cases. Disc pathology was detected in 44.7% (n=102) of the cases, and structural pathology was found in 14.9% (n=36). The most common disc pathology was bulging, constituting 32.9% (n=75) of the cases. There was no significant difference between the genders of the cases according to the incidence of disc pathology (p=0.434). When age and incidence of disc pathology were evaluated, the age of the group with disc pathology was significantly higher than the group without disc pathology (p
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Pate JW, Joslin R, Hurtubise K, Anderson DB. Assessing a child or adolescent with low back pain is different to assessing an adult with low back pain. J Paediatr Child Health 2022; 58:566-571. [PMID: 35218582 PMCID: PMC9303678 DOI: 10.1111/jpc.15933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/10/2022] [Accepted: 02/16/2022] [Indexed: 11/28/2022]
Abstract
In contrast to an assessment of an adult presenting with low back pain (LBP), clinicians should utilise different approaches when assessing children and adolescents presenting with LBP. Children are not 'little adults'. There are some unique pathologies that only occur in this age group: (i) serious pathologies include infection, fracture, child abuse and malignancy; (ii) growth-related pathologies include scoliosis, Scheuermann's disease, pars fracture and spondylolysis; and (iii) rheumatological conditions include juvenile idiopathic arthritis and ankylosing spondylitis. With changes in each child occurring physically, emotionally and socially, a clinician's knowledge of typical developmental milestones is essential to identify regression or delayed development. When listening to a child discuss their pain experience, a flexible structure should be implemented that gives the capacity to actively listen to a child's narrative (and that of their guardian) and to conduct an effective physical examination. This viewpoint also summarises the relationship between potential clinical diagnoses and key elements of a physical examination. Deciding on the type and timing of paediatric-specific physical examination tests requires unique child-centred considerations. Paediatric-specific outcome measures should be used but implemented pragmatically, with consideration regarding the time, complexity and pathology suspected. Systematic and rigorous approaches to both treatment planning and re-assessment are then proposed for the assessment of children and adolescents presenting with LBP.
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Affiliation(s)
- Joshua W Pate
- Graduate School of HealthUniversity of Technology SydneySydneyNew South WalesAustralia
| | - Rhiannon Joslin
- Faculty of Health SciencesUniversity of SouthamptonSouthamptonUnited Kingdom
| | - Karen Hurtubise
- CanChild Centre for Childhood Disability Research, School of Rehabilitation SciencesMcMaster UniversityHamiltonOntarioCanada
| | - David B Anderson
- Faculty of Health SciencesUniversity of SouthamptonSouthamptonUnited Kingdom,Faculty of Medicine and Health, Sydney School of Health SciencesUniversity of SydneySydneyNew South WalesAustralia
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Nolte MT, Harada GK, LeDuc R, Sayari AJ, Basques BA, Louie PK, Colman MW, Goldberg EJ, DeWald CJ, Phillips FM, Kogan M, An HS, Samartzis D. Pediatric Back Pain: A Scoring System to Guide Use of Magnetic Resonance Imaging. J Pediatr Orthop 2022; 42:116-122. [PMID: 34995265 DOI: 10.1097/bpo.0000000000002026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The prevalence of back pain in the pediatric population is increasing, and the workup of these patients presents a clinical challenge. Many cases are selflimited, but failure to diagnose a pathology that requires clinical intervention can carry severe repercussions. Magnetic resonance imaging (MRI) carries a high cost to the patient and health care system, and may even require procedural sedation in the pediatric population. The aim of this study was to develop a scoring system based on pediatric patient factors to help determine when an MRI will change clinical management. METHODS This is a retrospective cohort analysis of consecutive pediatric patients who presented to clinic with a chief complaint of back pain between 2010 and 2018 at single orthopaedic surgery practice. Comprehensive demographic and presentation variables were collected. A predictive model of factors that influence whether MRI results in a change in management was then generated using cross-validation least absolute shrinkage and selection operator logistic regression analysis. RESULTS A total of 729 patients were included, with a mean age of 15.1 years (range: 3 to 20 y). Of these, 344 (47.2%) had an MRI. A predictive model was generated, with nocturnal symptoms (5 points), neurological deficit (10 points), age (0.7 points per year), lumbar pain (2 points), sudden onset of pain (3.25 points), and leg pain (3.75 points) identified as significant predictors. A combined score of greater than 9.5 points for a given patient is highly suggestive that an MRI will result in a change in clinical management (specificity: 0.93; positive predictive value: 0.92). CONCLUSIONS A predictive model was generated to help determine when ordering an MRI may result in a change in clinical management for workup of back pain in the pediatric population. The main factors included the presence of a neurological deficit, nocturnal symptoms, sudden onset, leg pain, lumbar pain, and age. Care providers can use these findings to better determine if and when an MRI might be appropriate. LEVEL OF EVIDENCE Level III-diagnostic study.
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Affiliation(s)
- Michael T Nolte
- International Spine Research and Innovation Initiative, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
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Ozdemir S, Gencbas D, Tosun B, Bebis H, Sinan O. Musculoskeletal Pain, Related Factors, and Posture Profiles Among Adolescents: A Cross-Sectional Study From Turkey. Pain Manag Nurs 2021; 22:522-530. [PMID: 33414011 DOI: 10.1016/j.pmn.2020.11.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 09/19/2020] [Accepted: 11/29/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE The aim of the study was to evaluate musculoskeletal pain due to mechanical reasons and related risk factors in adolescents and to define posture profiles of adolescents. DESIGN A cross-sectional study. METHODS The study was conducted with 2221 adolescents between February 2015 and May 2015. The questionnaire used to collect data consisted of three parts: (1) descriptive characteristics of the participants, (2) pain assessment of 14 parts of the body, and (3) Back Pain and Body Posture Evaluation Instrument (BackPEI). RESULTS The prevalence of low back pain among the participants was 73.3% (n = 1,343), while the prevalence of back pain was 68.4% (n = 1,254). The participants attributed their pain to their poor sitting postures at school (38.1%, n = 847) and carrying school backpacks (84.1%, n = 1,713). There was a statistically significant difference in the physical activities of adolescents and the BackPEI score (z = 4.40; p = .001). Posture factors of the BackPEI score increased while school desk comfort score increased (Spearman's rho = 0.148; p = .001), but it decreased while the school grades of the adolescents increased (Spearman's rho [ρ] = -0.161; p = .001). CONCLUSIONS According to this study, body posture was related to musculoskeletal pain and was correlated with physical activities, school desk comfort, and school grades of the adolescents. It is suggested that correct posture and ergonomic positions should be taught to adolescents when using computers, carrying school backpacks, and sitting in school chairs to prevent musculoskeletal pain.
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Affiliation(s)
- Serpil Ozdemir
- Department of Public Health Nursing, University of Health Sciences Turkey, Ankara, Turkey.
| | - Dercan Gencbas
- Department of Nursing, Atilim University, Ankara, Turkey
| | - Betul Tosun
- Department of Nursing, Hasan Kalyoncu University, Gaziantep, Turkey
| | - Hatice Bebis
- Public Health Nursing Department, Near East University, Nicosia, Cyprus
| | - Ozlem Sinan
- Department of Public Health Nursing, Yildirim Beyazit University, Ankara, Turkey
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Lee TTY, Cheung JCW, Law SY, To MKT, Cheung JPY, Zheng YP. Analysis of sagittal profile of spine using 3D ultrasound imaging: a phantom study and preliminary subject test. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING: IMAGING & VISUALIZATION 2019. [DOI: 10.1080/21681163.2019.1566025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Timothy Tin-Yan Lee
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, China
| | - James Chung-Wai Cheung
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, China
| | - Siu-Yu Law
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, China
| | - Michael Kai Tsun To
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, China
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Calloni SF, Huisman TA, Poretti A, Soares BP. Back pain and scoliosis in children: When to image, what to consider. Neuroradiol J 2017; 30:393-404. [PMID: 28786774 DOI: 10.1177/1971400917697503] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Back pain and scoliosis in children most commonly present as benign and self-limited entities. However, persistent back pain and/or progressive scoliosis should always be taken seriously in children. Dedicated diagnostic work-up should exclude etiologies that may result in significant morbidity. Clinical evaluation and management require a comprehensive history and physical and neurological examination. A correct imaging approach is important to define a clear diagnosis and should be reserved for children with persistent symptoms or concerning clinical and laboratory findings. This article reviews the role of different imaging techniques in the diagnostic approach to back pain and scoliosis, and offers a comprehensive review of the main imaging findings associated with common and uncommon causes of back pain and scoliosis in the pediatric population.
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Affiliation(s)
- Sonia F Calloni
- 1 Università degli Studi di Milano, Postgraduation School in Radiodiagnostics, Italy.,2 Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, USA
| | - Thierry Agm Huisman
- 2 Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, USA
| | - Andrea Poretti
- 2 Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, USA.,3 Department of Neurogenetics, Kennedy Krieger Institute, USA
| | - Bruno P Soares
- 2 Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, USA
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Nahle IS, Hamam MS, Masrouha KZ, Afeiche NE, Abdelnoor J. Back pain: A puzzle in children. J Paediatr Child Health 2016; 52:802-8. [PMID: 27535879 DOI: 10.1111/jpc.13291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2016] [Indexed: 11/27/2022]
Abstract
Back pain in children is underdiagnosed and increases incidence in adolescence. A systematic approach can diagnose the most common causes: trauma, structural deformities, inflammatory diseases, infection and malignancy.
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Affiliation(s)
- Imad S Nahle
- Division of Orthopaedic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohamed S Hamam
- Division of Orthopaedic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Karim Z Masrouha
- Division of Orthopaedic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nadim E Afeiche
- Division of Orthopaedic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Johnny Abdelnoor
- Division of Orthopaedic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.,Department of Orthopaedic Surgery, University Medical Center - Rizk Hospital, Beirut, Lebanon
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Matziou V, Vlachioti E, Megapanou E, Ntoumou A, Dionisakopoulou C, Dimitriou V, Tsoumakas K, Matziou T, Perdikaris P. Perceptions of children and their parents about the pain experienced during their hospitalization and its impact on parents’ quality of life. Jpn J Clin Oncol 2016; 46:862-70. [DOI: 10.1093/jjco/hyw074] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 05/19/2016] [Indexed: 11/13/2022] Open
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Dizdarevic I, Bishop M, Sgromolo N, Hammoud S, Atanda A. Approach to the pediatric athlete with back pain: more than just the pars. PHYSICIAN SPORTSMED 2015; 43:421-31. [PMID: 26513167 DOI: 10.1080/00913847.2015.1093668] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Back pain in a pediatric patient can present a worrisome and challenging diagnostic dilemma for any physician. Although most back pain can be attributed to muscle strains and poor mechanics, it is necessary to appreciate the full differential of etiologies causing back pain in the pediatric population. The physician must recognize areas of mechanical weakness in the skeletally immature spine and the sport specific forces that can predispose a patient to injury. A comprehensive history involves determining the onset, chronicity, and location of the pain. A focused physical exam includes a neurological exam as well as provocative testing. The combination of a thorough history and focused physical exam should guide appropriate imaging. Radiographic tests are instrumental in narrowing the differential, making a diagnosis, and uncovering associated pathology. Treatment modalities such as activity modification, heat/cold compresses, and NSAIDs can provide pain relief and allow for effective physical therapy. In most cases nonoperative methods are successful in providing a safe and quick return to activities. Failure of conservative measures requires referral to an orthopedic surgeon, as surgical intervention may be warranted.
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Affiliation(s)
| | - Meghan Bishop
- b 2 Thomas Jefferson University , Philadelphia, PA, USA
| | | | - Sommer Hammoud
- d 4 Department of Orthopaedic Surgery, Thomas Jefferson University , Philadelphia, PA, USA
| | - Alfred Atanda
- e 5 Department of Orthopedic Surgery, Nemours/Alfred I. duPont Hospital for Children , Wilmington, DE, USA
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Influence of the Weight of a School Backpack on Spinal Curvature in the Sagittal Plane of Seven-Year-Old Children. BIOMED RESEARCH INTERNATIONAL 2015; 2015:817913. [PMID: 26413545 PMCID: PMC4564613 DOI: 10.1155/2015/817913] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 07/22/2015] [Accepted: 08/18/2015] [Indexed: 11/18/2022]
Abstract
The aim of the paper was to determine a correlation between the weight of a child's backpack, their body weight, and certain features of their body posture. Material and Methods. The study group consisted of 109 children, all aged seven years. The parameters of body posture were determined using the Zebris Ultrasonic System. Results. The number of children carrying a school backpack in accordance with recommendations was 44 subjects (40.37%). Statistically significant changes were found in the total length of the spine (Z = 2.223, p = 0.026) and between backpack weight and changes in the following parameters: the total length of the spine (rs = −0.3999, p = 0.017), the length and the angle of the lumbar lordosis (rs = −0.3352, p = 0.049), the angle of the lumbar lordosis (rs = −0.5065, p = 0.002), and the sacral angle (rs = −0.4279, p = 0.010). Conclusions. Wearing a backpack heavier than 10% of one's body weight can cause shallowing of the lumbar lordosis and a tendency towards a vertical position of the sacrum. Monitoring the weight of children's school backpacks and enabling them to leave books and notebooks at school would probably be beneficial in reducing the daily burden put on children's spines.
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Cruikshank M, Ramanan AV. Fifteen-minute consultation: a structured approach to the management of a child or adolescent with back pain. Arch Dis Child Educ Pract Ed 2014; 99:202-7. [PMID: 24711372 DOI: 10.1136/archdischild-2013-304932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
UNLABELLED Back pain in childhood is relatively unusual, although as a child matures through adolescence it becomes much more common. At any age, potentially serious illnesses need to be excluded. There are some useful red flags to be aware of when taking a history and performing an examination. We outline a systematic approach when faced with this clinical presentation in a general paediatric setting, with suggestions for initial investigations and when to consider referral to a specialist. OBJECTIVE To provide a structured approach for the paediatrician to appropriately manage a child or adolescent who presents with back pain. METHOD Review of the literature and description of the approach commonly adopted in a paediatric setting. Extended matching case questions are used to help the reader test their understanding. CONCLUSIONS A focused history, specifically asking about red flags, and a careful examination are essential to reach an appropriate differential diagnosis and management plan. Onward referral to a specialist may be required.
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Affiliation(s)
- Mary Cruikshank
- Department of Paediatric Rheumatology, Royal Hospital for Sick Children, Edinburgh, UK
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Affiliation(s)
- Manuele Lampasi
- Divisione di Ortopedia e Traumatologia Pediatrica, Rizzoli Orthopaedic Institute, Bologna, Italy.
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