Reasons for diagnostic difficulties in spinal defects and deformations in children and adolescents

Background. The growing spine is vulnerable to pathological processes in the bony, muscular or nervous tissue of the spine, with symptoms that include disturbances of the spinal axis in both planes. The clinical picture often corresponds to idiopathic scoliosis. Radiographic examinations done routinely mostly do not show any pathology in the initial period of disease growth. The aim of our study was to present diagnostic problems in children and adolescents treated "routinely" with the diagnosis of a posture defect or scoliosis. Material and methods. The material included 25 girls and boys mistakenly diagnosed and treated for scoliosis, while the hidden etiology delayed proper treatment. Results. In 12 cases the reason for deformity was osteoid osteoma of the spine, in 2 cases astrocytoma, in 2 others, meningioma, and in the others, hidden congenital defects of the vertebrae. In most cases, scoliosis were diagnosed due to a misleadingly typical clinical picture. All the examined patients needed surgical treatment. In cancer processes, the clinical diagnosis was confirmed by histopathologic examination. Conclusions. These examples of defects and deformities of spine caused by hidden pathological process indicate the necessity of thorough evaluation of every posture deformity in children and adolescents. Early diagnosis and surgical removal of the cause of deformity in all cases led to inhibition of the tumor or reduction of spinal deformity. Our observations indicate the risk of mass screening examinations, after which selected children are referred for treatment without diagnosis. Such therapeutic mistakes can be dangerous and delay proper treatment.