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

Full access? Get Clinical Tree
Get Clinical Tree app for offline access