What causes back pain in childhood?
Back and neck pain are relatively rare complaints in young children (unlike the situation in adolescents and adults) and should be taken very seriously. Although infection of an intervertebral disc space is rare secondary to osteomyelitis of an adjoining vertebral body, acute discitis should be considered. Discitis is an inflammatory process that occurs throughout childhood, with a peak at age 1 to 3 years and most cases occurring before the age of 8 years. It may be caused by pathogens of low virulence (e.g., viruses, Staphylococcus , Enterobacteriaceae, or Moraxella ), although bacteria or viruses are seldom recovered by aspiration. Fever, refusal to walk, unusual posturing, stiffness, and point tenderness over the lumbar region are characteristic. The ESR is usually moderately elevated. Plain radiographs may show disc-space narrowing, although often not until late in the disease. Earlier in the course, MRI or Tc-99m bone scan are abnormal and valuable diagnostically at the time of presentation.
In addition, malignancy (e.g., metastases, primary bone tumors, or leukemia) should be considered as well as ERA/JAS . However, JAS generally presents as peripheral arthritis (75% of children at presentation), with back complaints (pain, stiffness, or limitation of motion of the lumbosacral spine or sacroiliac joints) only reported by 25% of affected children prior to the third decade. Back pain is uncommon in JIA before adolescence.
Spondylolysis, with or without spondylolisthesis, may cause chronic back pain. Scheuermann disease or, rarely, herniation of an intervertebral disc results in pain in the lower thoracic or lumbar region.
