What is it about ?
Prolonged back pain (back pain) in a child is usually caused by an abnormality either in one or more vertebrae or in one or more discs between the vertebrae (intervertebral discs).
In about 65% of children under 10 years of age, the cause of back pain is found. It could be a fracture or crack, scoliosis (see below), infection, tumor or systemic disease (leukemia). In about 35% of children with back pain, there is no clear cause.
Additional examinations are necessary if the pain causes difficulty in walking or makes physical activity more difficult. Severe back pain in children over 10 years old is often caused by a tumor (osteoid osteoma), infection or systemic disease (leukemia).
How to recognize them and what can the doctor do?
Depending on the cause of the back pain, other movements may also be painful, or associated symptoms may occur, such as fever or weight loss.
The back pain caused by (excessive) load on the vertebrae are common in children and adolescents who exercise a lot. These pains are harmless. This type of back pain is linked to sports where the back is often bent, such as apparatus gymnastics, figure skating, and ballet dance. Limiting these physical efforts for 3 months usually improves symptoms. Most children can then resume their previous sports without symptoms. Sometimes spondylolysis occurs: it is a fracture or crack of the posterior part of the vertebra (the vertebral arch). It sometimes occurs without causing pain, but can also cause lower back pain that gets worse when standing or sitting.
The diagnosis is made by means of an x-ray and, in some cases, also a MRI (NMR imaging). By avoiding the sport in question and possibly replacing it with a less heavy sport, the problem often resolves itself.
We are talking about spondylolisthesis in the event of slippage of two vertebral bodies relative to each other following a fracture on both sides of the same vertebral arch in a child with spondylolysis. This may not be accompanied by symptoms, but sometimes causes lower back pain with stiff muscles in the back of the thighs. The diagnosis is made by means of an x-ray. Here too, the problem can be solved by avoiding the sport in question or by replacing it with a less heavy sport. In some cases, surgery is necessary if the vertebral bodies have moved too far apart or there is persistent pain.
The scoliosis is a lateral deviation of the spine; it is frequent. It is either a posture anomaly (correctable by muscle tension), or a real non-correctable deviation. The diagnosis is made by means of an x-ray. The treatment depends on the degree of deviation. Sometimes a simple follow-up is enough; sometimes a corset is needed. If the curvatures are very severe, an operation is necessary, because, without treatment, heart and lung problems can develop in the long term.
Rare diseases
Calvé’s disease (or vertebral osteochondritis or “vertebra plana”) affects children between 2 and 10 years old. The vertebra is completely sagged, which can cause severe pain. The diagnosis is made on the basis of an MRI, and a biopsy should always be done to rule out bacterial infection or tuberculosis.
A discite is an inflammation that affects one or more intervertebral discs. It can occur spontaneously or be due to a bacterial infection. The diagnosis is made by means of a MRI. In case of bacterial infection, long-term antibiotics should be given by infusion.
In case of intense nighttime pain, consider a tumor at the level of the vertebrae.
a intervertebral disc prolapse can be explained by a poorer quality of the intervertebral discs. It can already manifest itself very early in childhood. Sometimes this can lead to a herniated disc (= protrusion of the nucleus of the intervertebral disc), then there is a risk of compression of the spinal cord. The diagnosis is made by means of a MRI. In children with a herniated disc, surgery is required faster than in adults.
How is the diagnosis made?
In a child over 10 years of age, a careful clinical examination and an X-ray of the back are usually sufficient for an initial examination to detect structural causes. If the results are abnormal, a more specialized exam, such as an MRI of the back, may be done.
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