The difficulty in determining the prevalence of back pain in the pediatric population in part may be related to the following: 1) differences among practitioners in defining back pain, 2) variability in the time period assessed, 14, 15 and 3) the small number of prospective studies on the epidemiology of low back pain in children. By 18 years of age in girls and 20 years of age in boys, Leboeuf-Yde and Kyvik 13 demonstrated that >50% of these children had experienced at least 1 episode of low back pain. 9 Sato et al 4 recently reported a lifetime prevalence of 28.8% in Japanese children, increasing to 42.5% in junior high school. A cross-sectional study performed in a Danish population showed a dramatic increase in the prevalence of low back pain in the early teen years. Burton et al 12 demonstrated a lifetime prevalence increase from 12% at 11 years of age to 50% at 15 years of age. Jones et al 8 reported an average lifetime prevalence of back pain of 40.2% in 500 children between 10 and 16 years of age. The prevalence of back pain in children and adolescents varies widely from 12% to 50%. This review article covers the epidemiology, clinical evaluation, imaging work-up, and imaging findings of entities causing back pain in children. 9 More recent studies have demonstrated lower rates of identifiable disease. 8Īs a rule, when children present with back pain, clinicians typically suspect more serious underlying disease this traditionally held view, in turn, has led to the practice of doing extensive work-ups to determine possible etiologies. Although recent studies have shown an increased prevalence of back pain in children, 3 – 7 relatively few patients receive medical attention. Back pain in children presenting to the emergency department was originally thought to be an uncommon complaint, 2 reflecting significant underlying pathology compared with adults. The incidence of back pain in adults has been estimated to be as high as 60%–80% 1 the actual incidence of back pain in children, however, is unknown. The list of diseases giving rise to back pain is not meant to be exhaustive but rather reflective of the most commonly identified pathologies and disorders among young children and adolescents, from athletic injuries to lethal cancers.Ībbreviations ALARA as low as reasonably achievable ESR erythrocyte sedimentation rate FSE fast spin-echo 18F fluorine 18 LCH Langerhans cell histiocytosis LDH lactate dehydrogenase MBP mechanical back pain PET positron-emission tomography RFA radio-frequency ablation SPECT single-photon emission computed tomography STIR short tau inversion recovery 99mTc-MDP technetium 99m methylene diphosphonate WHO World Health Organizationīack pain in children presents less frequently than in adults. This article describes 1) the epidemiology of back pain in children, 2) the imaging work-up used, and 3) the correlation of imaging findings with disease entities that may cause back pain in the pediatric patient. Pediatric patients are evaluated, first, with a complete clinical history and examination and, second, by an imaging work-up that is based on initial findings, including the child's age and size, signs and symptoms, and suspected etiology. When children have back pain and medical attention is sought, an underlying pathology is usually suspected. SUMMARY: While back pain presents less frequently in children than in adults, it still poses a significant clinical challenge with respect to making a firm diagnosis and developing an effective treatment plan.
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