Back Pain in Children
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1 Back Pain in Children
2 back pain?
3 back pain 10 ~ 30 % (up to 50 % by Questionnaire) 10 : rare (11 : 11%, 15 : 50%) : Back pain 2 ~ 8 % : (+) up to 50% if :
4 Significant vs. Non-significant Red flag (Fever, weight loss ) Neurologic findings Non-mechanical (night pain, rest pain) Behavior >> History taking
5 Significant back pain, Back pain 4 3 Night pain, sleep disturbance
6 LBP The cause can t be identified in most LBP pts. Psychological stress LBP : rarer LBP d/t Growing pain : (X) Activity-related LBP : (O)
7 Back pain (Fever, malaise, weight loss, anorexia) Bladder, bowel habit (,, )
8 Pain character Aggrevating or Alleviating factors Rest, activity Aspirin Coughing : mechanical pain : Ost. osteoma, osteoblastoma : HIVD, tumor Hyperextension : pars defect
9 Physical examination SLR Hamstring tightness Spine asymmetry Neurologic deficit F / 15
10 Spondylolysis, -listhesis : 33% Scheuermann s kyphosis : 33% Tumor, Infection : 18% Unknown, : 15% (Hensinger RN, 1985) Reliability??
11 10 tumor, infection, 10 spondylolysis, -listhesis, Scheuermann s kyphosis Tumor (6~11%)
12 back pain Mechanical : Strain, overuse, HIVD Developmental : Pars defect, Scheuermann s K. Infectious & inflammation : Discitis, OM Tumor : Benign & malignant Psychogenic Referred pain : from visceral disorders Idiopathic
13 Tumorous conditions
14 malignant tumors?? Leukemia 10, night-time back pain
15 bony malignancy?? Ewing s sarcoma Osteosarcoma
16 benign tumors?? Osteoid osteoma Osteoblastoma Eosinophilic granuloma
17 Spinal cord tumor?? Astrocytoma Ependymoma
18 soft tissue tumor?? Rhabdomyosarcoma
19 metastatic tumor?? Neuroblastoma
20 M/7 Back pain
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22 F / 10 Eosinophilic granuloma
23 M / 14 Congenital scoliosis c.c. : Sudden paraparesis
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26 1
27 Osteomyelitis & Discitis
28 F / 5 : Activity diminished, back pain
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32 1
33 : 6 3 : Refusal to walk 3~8 : Abdominal pain 10 : HIVD - like features (SLR limitation) Fever : 28%
34 Organism identified : 30~60% (Staphylococcus aureus) X-ray changes : 4~5 weeks later MRI, bone scan Mostly, resolved with conservative Tx
35 F / 6 Back pain
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37 2
38 Scheuermann s kyphosis
39 X-RAY 3 consecutive V.B. each > 5 wedging Thoracic kyphosis > 45 (N : 20~40 ) 65 Endplate irregularities Disc space narrowing Schmorl s node
40 Multiple Schmorl s node Vertebral body wedging Kyphosis & back pain
41 1 ~ 8% ( ) Peak incidence : 13 ~ 17 years Aseptic necrosis of verteb. ring apophysis? Scoliosis in 30% Pars defect in up to 30%
42 Postural kyphosis Compression fracture Congenital kyphosis Tuberculous kyphosis Neuromuscular disease
43 Observation & Exercises Brace treatment : 45 ~ 65 Surgery 65 persistent excessive pain neurologic deficit
44 Lumbar HIVD
45 F/15 SLR : 20 / 10
46 Lumbar HIVD 1~3% of all HIVD 10% Sciatica, SLR limitation, hamstring tightness ( : LBP in 98%) Variant : Apophyseal ring fracture
47 M / 16 : Left sciatica
48 : Left sciatica : Sciatica, LBP : E.S.I., E.S.I :,
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56 vs
57 Lumbar Apophyseal Ring Fracture (LARF) Slipped vertebral ring apophysis HIVD 15% L 4-5 segment CT > > MRI
58 O : F/ 17, LBP & Right sciatica (for 5 years) 10
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60 Spondylolysis & Spondylolisthesis
61 Spondylisthesis & Spondylolysis Active back pain up to 47% Mostly Isthmic or Dysplastic at L5-S1 Sports (hyperextension) related : 4~6 (,,, ) history in 25%( ) ~ 50%( )
62 Unilateral defect : 20% Incidence increasing with age 4 : very rare 6 : 4% 10 : 6% Related with increasing L. lordosis?? (30% of Scheuermann have pars defect) Racial differences : 40% of Eskimo
63 Natural history 30-50% slip in most patients slip, F/U further slip 10% Lytic defect : 2 High grade slip : 4
64 Phalen-Dickson sign : knee-bent, hip flexed gait stiff legged, short stride : Hamstring tightness Lumbosacral kyphosis
65 Roentgenographic parameters Translation Slip angle Sagittal rotation Sacral inclination L. index (trapezoidal L5)
66 parameters Slippage (or translation) L S kyphosis % Slippage Slip angle
67 Wiltze s guideline 25% slippage & No symptom : x-ray F/U 25 50% slippage & No symptom : F/U & 50% slippage & symptom (+) : or 50% slippage Slippage < 25% LBP (+) Slip angle : 12 :
68 Repair of defects Decompression In situ posterior fusion Reduction & fusion Anterior fusion L5 vertebrectomy
69 Reduction Improve L-S kyphosis (not translation) L4 & sacrum should be in lordotic position Normal Severe slip Reduction: unsatisfactory Reduction: satisfactory
70 F / 15 Low back pain
71 1 year follow up
72 O : F/ 11, severe LBP (for 2 years)
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74 F / 15 Ankle weakness
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76 Immediate postop.
77 Postop. 1 year
78 level approach P/E : Local or Systemic or Neurologic : 1 or
79 Level I II III IV P/E Findings Local Local significant (Hamstring tight, Spine asymmetry) Local significant Systemic sign Additional Neurologic sign 1mo Symtomatic treatment 1mo 1mo 1mo Management X-ray X-ray,, Bone scan add MRI
80 Public Relations ( )
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Ankylosing Spondylitis 1 Ankylosing Spondylitis Marie-strumpell, Bechterew, (pelvospondylitis ossificans). (ossification), (sacroiliac joint),.,.,,.,.., NSAIDs(Non-Steroidal Anti-Inflammatory Drugs),.
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기관고유연구사업결과보고 작성요령 2001 ~ 2004 2005 ~ 2007 2008 ~ 2010 2001 ~ 2004 2005 ~ 2007 2008 ~ 2010 1 2/3 2 1 0 2 3 52 0 31 83 12 6 3 21 593 404 304 1,301 4 3 1 8 159 191 116 466 6 11 (`1: (1: 16 33 44 106