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