Pediatric emergency medicine trisk 1063 1063
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management. Plain film radiographs are the starting point for most conditions that
present with back pain which require imaging. Anterior–posterior and lateral
views of the spine will diagnose fractures, bony tumors, scoliosis, kyphosis, and
lordosis. Oblique views provide superior views of the pars interarticularis and can
diagnose spondylolysis or spondylolisthesis. However, given the low sensitivity
of plain films, advanced imaging is often indicated if clinical suspicion is high.
Computed tomography is indicated for evaluation of acute, high-force trauma to
the back, otherwise, MRI is often the study of choice. The urgency of obtaining
an MRI depends on the type and severity of symptoms, the presence of
neurologic findings on examination, and concerning labs or plain films. MRI is
extremely sensitive for spinal cord lesions, osteomyelitis, discitis, and vertebral
fractures.
Back pain in children deserves a careful and comprehensive evaluation.
Management of back pain in children and adolescents depends upon the specific
etiology. Nonsteroidal anti-inflammatory drugs are first-line treatment of
nonspecific low back pain. Because back pain is a relatively uncommon chief
complaint and there is potential for significant pathology, close follow-up of
patients, especially younger children, presenting with back pain should be
ensured.
Suggested Readings and Key References
Brooks TM, Friedman LM, Silvis RM, et al. Back pain in a pediatric emergency
department: etiology and evaluation. Pediatr Emerg Care 2018;34(1):e1–e6.
MacDonald J, Stuart E, Rodenberg R. Musculoskeletal low back pain in schoolaged children: a review. JAMA Pediatr 2017;171(3):280–287.
Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet
2017;389(10070):736–747.
Nahle IS, Hamam MS, Masrouha KZ, et al. Back pain: a puzzle in children. J
Paediatr Child Health 2016;52(8):802–808.
