Abstract
Introduction and Aims: Children and adolescents with back pain are a challenging problem for the orthopaedic surgeon. The differential diagnosis includes tumors and infection. The aim of this retrospective review was to determine the incidence amongst the study population and ascertain the clinical markers that could help clinicians to diagnose the underlying pathology.
Method: A clinical records database search identified a cohort of 59 consecutive patients referred to one of two paediatric spinal surgeons with the diagnosis of back pain between January 2000 and July 2003. The record analysis included chart review, radiographic analysis and clinical follow-up at the Starship Children’s Hospital. Patients were excluded from the study if they were referred with a known cause of back pain, had previous spinal surgery or a cervical distribution of pain.
Results: New back pain referrals represented 1.7% of all new referrals to this tertiary level orthopaedic department. There were 59 patients with 32 (54%) females and 27 (46%) males. The average age at presentation was 12 years and the average duration of symptoms was 15.5 months. The most common site of pain was lumbosacral (61%). All patients had plain radiograph studies performed, 28 (47.5%) a bone scan, nine (15%) a CT scan and 15 (25.5%) an MRI. In addition, 21 patients (35.5%) had laboratory investigations including a FBC, ESR and c-reactive protein.
Thirty-four patients representing 58% of the study group had a definitive dignosis made. Fourteen patients (24%) had Scheuerman’s disease, seven (12%) were dignosed with spondylolisthesis and five (8.5%) had a painful scoliosis. Only one patient had osteomyelitis. We did not identify any patients with a tumor.
Patients older than 10 years were almost twice as likely to have a positive diagnosis than those under 10 years of age. There was no single reliable clinical sign or symptom that would help make the diagnosis. Significant haematological abnormalities were only found in one patient who was diagnosed with sacral osteomyelitis. Plain radiographs alone provided the diagnosis in 14 (23.5%) patients. Bone scan, CT and MRI were of variable diagnostic value.
Conclusion: Back pain in children has traditionally been regarded serious enough to warrant comprehensive investigation. We have found a definitive diagnosis in only 58% of patients despite thorough clinical assessment, and haematological and radiological evaluation. Clinicians must remain vigilant for any clues that may help lead to a diagnosis in this group of patients.
These abstracts were prepared by Editorial Secretary, George Sikorski. Correspondence should be addressed to Australian Orthopaedic Association, Ground Floor, The William Bland Centre, 229 Macquarie Street, Sydney, NSW 2000, Australia.
At least one of the authors is receiving or has received material benefits or support from a commercial source.
