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Pediatric Back Pain Does not Always Have Definitive Diagnosis

Low back pain, very common among adults in industrialized countries, was never thought to be a common issue for children. According to early studies, it was estimated that about two percent of the pediatric population experienced low back pain.

These numbers are changing, however. Recent studies have shown that almost one-quarter of adolescents have seen a doctor with complaints of low back pain and the incidence may be as high as 36 percent by the time in adolescents up to age 15 years. This percentage rises to 37.1 percent among adolescents who are competitive athletes.

Because of the implied low number of children who complained of back pain, the medical community often considered child lower back pain as having a very serious cause. However, recent studies have shown that the children's complaints may have causes that are not all that different from adult low back pain.

The authors of this study wanted to evaluate the diagnosis of children with low back pain. To do so, they enrolled 73 children who complained of back pain that lasted more than three months and they had not had spinal surgery. They underwent physical examination, x-rays, bone scans and blood tests. If the patients' bone scans were positive but their x-rays were negative (nothing was seen), they were followed up with a computed tomography imaging scan (CT scan). Patients with neurological (nervous system) symptoms or who seemed to get worse also had magnetic resonance imaging, or MRI, performed.

The test results showed that 57 patients had no definitive diagnosis following testing and follow up. Of the remaining 16 patients, nine were diagnosed with spondylosis, two with Scheuermann disease, and three with blood tests that were not normal but no diagnosis were made.

Ten of the 13 children with definitive diagnosis were diagnosed by x-rays. Two had negative x-rays but had positive bone scans. Three patients eventually had surgery.

In total, of the 73 children, all had x-rays, 62 had CT scans, 10 had MRIs, and 62 had blood tests.

The authors conclude that most of the diagnosis were made by x-ray and that there was a lower rate of diagnosable pathology in this group than had been reported in earlier studies. They wrote, "Exhaustive diagnostic protocols may not be necessary for [lower back pain in children]."

References: Nitin N. Bhatia, et al. Diagnostic Modalities for the Evaluation of Pediatric Back Pain. In Journal of Pediatric Orthopedics. March 2008. Vol. 28. No. 2. Pp. 230-233.

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