Minimally Invasive Spinal Interventions for Back and Neck Pain in the Pediatric Population: a Systematic Review

Area of Science:

• Pediatric pain management
• Interventional pain medicine
• Spinal procedures

Background:

• Chronic back and neck pain affect pediatric populations, often proving refractory to conservative treatments.
• Spinal interventions represent a potential therapeutic avenue for these challenging cases.
• Evaluating the efficacy and safety of these interventions in children is crucial.

Purpose of the Study:

• To systematically review the effectiveness and safety of spinal interventions for pediatric patients with chronic back and neck pain.
• To assess pain reduction and functional improvement following these procedures.
• To identify and analyze adverse events associated with spinal interventions in children.

Main Methods:

• A systematic review adhering to PRISMA 2020 guidelines was conducted.
• Searches included PubMed, Embase, Web of Science, and Cochrane Central up to August 2024.
• Included studies reported on interventional procedures for pediatric spinal pain, with outcomes assessed using subjective scales and validated instruments. Risk of bias and evidence certainty were evaluated using MASTER and GRADE scales.

Main Results:

• Eight studies involving 258 pediatric patients met the inclusion criteria.
• Common interventions included epidural steroid injections, sacroiliac joint injections, and facet injections.
• Reported pain relief and functional improvement were observed, with rare, mild, and transient adverse events. Evidence certainty was rated as 'very low' due to study limitations.

Conclusions:

• Spinal interventions show preliminary promise for pain relief and functional gains in pediatric patients unresponsive to conservative care.
• The safety profile appears comparable to that in adult populations.
• High-quality, larger, controlled studies are essential to establish definitive clinical guidelines due to current evidence limitations and heterogeneity.