Back Pain
Kevin R. Moore, MD
DIFFERENTIAL DIAGNOSIS
Common
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Scoliosis
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Idiopathic Scoliosis
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Neuromuscular Scoliosis
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Congenital Scoliosis
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Trauma
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Fracture
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Traumatic Spinal Muscle Injury
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Syringomyelia
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Spondylolysis
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Scheuermann Disease
Less Common
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Congenital Spinal Stenosis
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Guillain-Barré Syndrome
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Neoplasm
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Lymphoma
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Neuroblastic Tumor
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Ewing Sarcoma
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Myxopapillary Ependymoma, Spinal Cord
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CSF Disseminated Metastases
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Hematogenous Metastases
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Osteoid Osteoma
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Langerhans Cell Histiocytosis
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Osteomyelitis
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Granulomatous Osteomyelitis
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Pyogenic Osteomyelitis
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Rare but Important
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Intervertebral Disc Herniation
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Idiopathic Acute Transverse Myelitis
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Secondary Acute Transverse Myelitis
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
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Clinical history, physical examination, and appropriate laboratory investigations constrain differential considerations
Helpful Clues for Common Diagnoses
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Scoliosis
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Idiopathic Scoliosis
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Usually sigmoid S-shaped
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No vertebral segmentation anomalies
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Neuromuscular Scoliosis
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C-shaped curvature common
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Baclofen infusion device clue if present
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Congenital Scoliosis
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Vertebral segmentation and formation anomalies
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Trauma
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Fracture
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Similar criteria to adults
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Traumatic Spinal Muscle Injury
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MR or CT best for diagnosis
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T2WI FS MR or STIR MR most helpful for diagnosis, determining extent
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Syringomyelia
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Chiari 1 malformation common association in pediatric patients
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Always consider traumatic, neoplastic causes
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Administer contrast if tumor suspected or nodularity detected
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Spondylolysis
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Unilateral or bilateral; may not see osseous break (stress reaction)
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Oblique plain radiographs, MR show osseous defects well
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Bone scintigraphy sensitive for detecting stress reaction prior to pars fracture
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Scheuermann Disease
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Most common in adolescent age group
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Diagnostic criteria include anterior wedging, kyphosis, endplate irregularity
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May see significant kyphosis ± scoliosis
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Helpful Clues for Less Common Diagnoses
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Congenital Spinal Stenosis
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Reduced AP diameter of central spinal canal
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