Back Pain



Back Pain


Kevin R. Moore, MD



DIFFERENTIAL DIAGNOSIS


Common



  • Scoliosis



    • Idiopathic Scoliosis


    • Neuromuscular Scoliosis


    • Congenital Scoliosis


  • Trauma



    • Fracture


    • Traumatic Spinal Muscle Injury


  • Syringomyelia


  • Spondylolysis


  • Scheuermann Disease


Less Common



  • Congenital Spinal Stenosis


  • Guillain-Barré Syndrome


  • Neoplasm



    • Lymphoma


    • Neuroblastic Tumor


    • Ewing Sarcoma


    • Myxopapillary Ependymoma, Spinal Cord


    • CSF Disseminated Metastases


    • Hematogenous Metastases


    • Osteoid Osteoma


    • Langerhans Cell Histiocytosis


  • Osteomyelitis



    • Granulomatous Osteomyelitis


    • Pyogenic Osteomyelitis


Rare but Important



  • Intervertebral Disc Herniation


  • Idiopathic Acute Transverse Myelitis


  • Secondary Acute Transverse Myelitis


ESSENTIAL INFORMATION


Key Differential Diagnosis Issues



  • Clinical history, physical examination, and appropriate laboratory investigations constrain differential considerations


Helpful Clues for Common Diagnoses



  • Scoliosis



    • Idiopathic Scoliosis



      • Usually sigmoid S-shaped


      • Pelvic tilt image limb-length discrepancy


      • No vertebral segmentation anomalies


    • Neuromuscular Scoliosis



      • C-shaped curvature common


      • Baclofen infusion device clue if present


    • Congenital Scoliosis



      • Vertebral segmentation and formation anomalies


      • Rib fusions, pedicular bars image more likely progressive curvature


  • Trauma



    • Fracture



      • Similar criteria to adults


    • Traumatic Spinal Muscle Injury



      • MR or CT best for diagnosis


      • T2WI FS MR or STIR MR most helpful for diagnosis, determining extent


  • Syringomyelia



    • Chiari 1 malformation common association in pediatric patients


    • Always consider traumatic, neoplastic causes



      • Administer contrast if tumor suspected or nodularity detected


  • Spondylolysis



    • Unilateral or bilateral; may not see osseous break (stress reaction)


    • Oblique plain radiographs, MR show osseous defects well


    • Bone scintigraphy sensitive for detecting stress reaction prior to pars fracture


  • Scheuermann Disease



    • Most common in adolescent age group


    • Diagnostic criteria include anterior wedging, kyphosis, endplate irregularity


    • May see significant kyphosis ± scoliosis


Helpful Clues for Less Common Diagnoses

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Aug 10, 2016 | Posted by in PEDIATRICS | Comments Off on Back Pain

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