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Back pain in childhood
P G Turner1, J H Green, C S Galasko
1Department of Orthopaedic Surgery, Royal Manchester Children's Hospital, Pendlebury, England.
Insights
Pediatric back pain often indicates serious spinal disease, but clinical signs can be misleading. Normal initial tests allow for symptomatic treatment and observation before further investigation in children with back pain.
Area of Science:
- Pediatric Orthopedics
- Spinal Diagnostics
Background:
- Back pain in children is a significant concern, representing a small fraction of referrals.
- A substantial proportion of pediatric back pain cases involve serious spinal disease.
Purpose of the Study:
- To evaluate the diagnostic challenges and management strategies for pediatric back pain.
- To determine the reliability of clinical findings in identifying serious spinal disease in children.
Main Methods:
- Retrospective review of 61 children presenting with back pain between 1978 and 1984.
- Analysis of clinical findings, radiographic results, white cell count, and sedimentation rate.
Main Results:
- Approximately 50% of children had serious spinal disease.
- Clinical findings were often unreliable in distinguishing serious conditions.
- Normal radiographs, white cell count, and sedimentation rate were observed in some patients with serious disease.
Conclusions:
- Clinical assessment alone is insufficient for diagnosing serious spinal disease in pediatric back pain.
- Children with back pain and normal initial investigations (radiographs, blood tests) can be managed conservatively with observation.
- Invasive investigations should be considered only after a period of symptomatic treatment and observation if symptoms persist or worsen.
Abstract:
Sixty-one children with back pain presented to the authors' department between 1978 and 1984, accounting for less than 2% of referrals in this age group. Approximately 50% had serious spinal disease, yet clinical findings could be unreliable in distinguishing such patients. In the absence of compelling physical signs, children with normal radiographs, white cell count, and sedimentation rate can be treated symptomatically and observed for some months before more invasive investigations are considered.