Paediatric Back Pain

DDx

 

Spondylosis / spondylolisthesis

- most common cause

- adolescent playing sport

 

Scheuermann kyphosis
- 1/3 of patients

 

HNP - rare

Fracture

 

Apophyseal ring fracture

- traumatic fracture between vertebral body and cartilaginous ring

- apophysis displaced posteriorly with disc

- decompression if causes neurological symptoms

 

Discitis / Osteomyelitis

 

Tumour

- benign: OO / OB / ABC / Giant cell / EG

- malignant: Ewings / OS / Chordoma / Leukaemia

 

RA

Diastematomyelia

Juvenile Osteoporosis

 

Clinical

 

Pain character

- aspirin relief / night pain

- osteoid osteoma

 

Associated neurology & deformity

 

Systemic features / Red flag signs

- fever / weight Loss

 

X-ray

 

Standing PA & Lateral

 

CT

 

For spondylithesis

 

MRI

 

Low threshold

- may need GA

 

Bloods

 

WCC / ESR / CRP

RF, ANA, HLA B27