Back Pain and Children

Back pain in children and adolescents is on the rise in the United States, especially over the past decade. As high as 33 per cent of annual doctor visits reported are due to back pain in children. Probable theories for the rise of back pain incidence in children are an increase in sedentary lifestyles, obesity, and backpack use. A thorough evaluation is necessary to determine the cause of the child’s back pain. This includes physical observation of the spine, walking, as well as a basic neurological screen of the reflexes and sensation. If there is pin point pain, suspected neurological involvement or an obvious deformity, x-rays or MRIs are recommended. However, almost two thirds of reported back pain is none specific. If so, it is recommended the patient follow up with physical therapy.

While the majority of back pain in children is not due to alarming causes, there are some, albeit rare, conditions that practitioners need to be on alert for. The most common of these include spondylolysis, spondylolisthesis, Scheuermann kyphosis, overuse syndromes, disk herniation, apophyseal ring fracture, spondylodiscitis, vertebral osteomyelitis and neoplasm.

Spondylolysis is a stress fracture of one of the lumbar vertebra on the arch of the bone, often caused by excessive back bending activates. Spondylolythesis is when this fracture progresses and results in one vertebra slipping forward on the one below it. Depending on the severity, it can be treated with bracing, medication for pain relief and physical therapy, or can require surgery to fixate the segment.

Scheurmann kyphosis is often diagnosed in older adolescents during puberty. It involves an excessive curvature of the thoracic (middle to upper) spine. This is often painful and can interfere with lung function in more severe cases. Treatment for less severe curves consists of physical therapy and bracing. Severe curves require surgery for correction.

Lumbar disc herniation is less prevalent in the younger population than in the adult population. Surgery is reserved as a last resort treatment, and instead relative rest, physical therapy and anti-inflammatory medication is suggested.

Spondylodiscitis is an infection of the disc and is most appropriately treated with antibiotics. Surgery is a rarity, but can be necessary if there is compression on the spinal cord caused by the inflammation.

Neoplasms are a new, abnormal growth and often are associated with cancer. There are multiple types of neoplasms that can grow on the spine and cause back pain. Signs and symptoms indicating further imaging and blood work to diagnose such neoplasms range from night pain to back pain combined with lethargy and fever. Depending on the type of neoplasm and its growth rate, either monitoring with pain relieving medication or surgery is indicated. Sometimes bracing or vertebral fixation is necessary to improve spinal stability.

References: Shah, S., MD and Saller, J., MD. Evaluation and Diagnosis of Back Pain in Children and Adolescents. Journal of the American Academy of Orthopaedic Surgeons. January, 2016, Vol. 24, No. 1. Pp. 37-45.

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