BackpaininChilhoodNOC5thDec课件.ppt

Back pain in Childhood Joel David Nuffield Orthopaedic Centre Oxford Epidemiology 1 in 5 school age children have back pain More prevalent in the 14 – 16yr group cf. with 8 – 10yrs olds Differential Dx Mechanical Inflammatory Infective Neoplasia Metabolic Pain amplification Red flags The very young Persistent and increasing pain Weight loss Fever Ridicular symptoms Sphincter disturbance No response to appropriate therapy after 2 months Mechanical back pain Spondylolysis Spondylolisthesis Most common in L5 Occur esp. in adolescent athletic boys Most frequently asymptomatic No association with slippage and onset of back pain Spondylolysis more common in 1st order relatives Pain radiates down posterior thigh, elicited by pressure on vertebra Hyperextension with leg lift exacerbates pain Treatment usually conservative Resume activities once pain and ROM subsided Scheuermann’s Can affect up to 30% of population Usually asymptomatic Presents with back pain and / or kyphosis 11-15yrs Male athletes predisposed Pain more at end of day, exacerbated by forward flexion, relieved by rest Deformity increases on bending Pain does nor correlate with X-Rays Disc degeneration Rare in childhood Boys girls Majority L4/5 and L5/S1 Pain often insidious with stiffness, occasionally ridicular Coughing/ / sneezing and bending aggravate MRI imaging of choice Conservative treatment choice Relationship between early disc disease and low back pain in adulthood Idiopathic scoliosis Majority of progression occurs 12 -14years Usually painless Bracing controversial - thoraco-lumber othoses for 23hrs / day can halt progression Inflammatory back pain JIA Spondyloarthropathy usually does not involve the spine Discitis More common in younger age group, 4yrs L4/5 level commonest Organisms difficult to isolate, usually Staph. Aureus End plate becomes poorly defined and there is loss of joint space MRI investigation of choice Prognosis good, although fusion of adjacent vertebrae can occur In