Imaging of low back pain in children and adolescents

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In children with low back pain (LBP), a specific cause is often identified. LBP has a relatively high prevalence during school years. However, only a minority of the children suffering from LBP seek medical attention. Protracted back pain in childhood is a serious condition that should be thoroughly investigated. This article is a systematic review of the intrinsic causes of LBP. Imaging modalities are discussed, with emphasis on magnetic resonance imaging. We have divided the intrinsic causes of LBP into four main groups: mechanical, developmental, infectious/inflammatory, and neoplastic. Disk protrusion is prevalent in young athletes. Spondylolysis and spondylolisthesis are the most common causes of chronic LBP in children. Thoracic or thoracolumbar Scheuermann disease causes kyphosis while a lumbar localization is more painful. Childhood diskitis is associated with fever and leukocytosis. Spinal inflammatory arthritides in children include juvenile rheumatoid arthritis, the juvenile spondyloarthropathies, and SAPHO syndrome, where spine as well as sacroiliac joint changes may be seen. Cysts, tumors, tumor-like lesions, and metastases are infrequent causes of back pain in children. Several of these conditions are described and illustrated in this review of LBP in children and adolescents.

Section snippets

Mechanical and developmental causes

The entities included in this group are related to injuries, which may be associated with repetitive low grade trauma or a single major injury.

Infectious and inflammatory causes

Except for neuroarthropathy, where there is absence of sensation, diskitis and all other inflammatory and degenerative arthritides affecting the spine and/or sacroiliac joints may be associated with LBP.

Cysts and tumoral causes

Tumors are an infrequent cause of back pain in children.22 They can be either primary or secondary, in the spine, leptomeninges, or spinal cord. Imaging modalities for the evaluation of spinal tumors include plain radiographs, scintigraphy, CT, MRI, and in rare cases myelography.

Although CT and to a lesser extent plain radiographs help in demonstrating the presence and extent of bony involvement, MRI is often used in conjunction with CT for better delineation of the soft tissue component and

Conclusion

LBP in children and adolescents cannot be ignored. It is a serious condition that must be thoroughly investigated for a specific cause to be identified. This requires an accurate history, including family history, clinical and laboratory examinations, as well as tailored imaging. We have reviewed and illustrated many of the mechanical, developmental, infectious/inflammatory, and neoplastic causes of LBP in the pediatric age group and emphasized the role of MRI as a superb diagnostic tool.

Acknowledgment

We would like to thank Ms. Manon Roy and Ms. Nora Del Pozo for their help in preparation of this manuscript.

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