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| IMAGE QUIZ ARCHIVE | ||||||
| Image Quiz | ||
| Back Pain in an Eight-Year-Old Girl1 (continued) |
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| Answer: Intradural arachnoid cyst. | ||
| For larger view, click on image | ||
 Fig. 1-B |  Fig. 1-C | |
| Magnetic resonance T1-weighted (Fig. 1-B) and T2-weighted (Fig. 1-C) images showing the oval expansile cyst in the spinal canal at the second, third, and fourth sacral levels. | ||
| Discussion | ||
| According to a number of studies, the prevalence of back pain in children is between 11.5% and 36%, with less than 2% of these children being seen for medical attention2,3. Back pain can be secondary to trauma, infection, spondylolisthesis, disc degeneration, herniation of the intervertebral disc, or tumor2-12. Turner et al.3 reported on sixty-one children who presented with low-back pain. Approximately 50% had a serious spinal disease. All sixty-one patients had radiographs of the spine, which provided the diagnosis for twenty-three. The fact that a high percentage of the patients had a serious spinal abnormality supports the need for optimal radiographic visualization of the symptomatic area. | ||
| Because children are not always specific in localizing the area of concern, a thorough history and clinical examination are imperative2,10,13. The patient can sometimes describe the type and location of the symptoms, which can help the physician to determine the cause of the pain. Our patient had decreased pin-prick sensation, which alerted us to the possibility of a cause that was more serious than mechanical low-back pain. | ||
| If appropriate evaluation warrants radiographs of the pelvic or sacral area, these tests should be performed without lead-shielding by competent technicians using state-of-the-art equipment, to reduce the chances of repeat radiation exposure. Additional diagnostic studies, such as magnetic resonance imaging, may be needed to establish the diagnosis6,13-15. | ||
| Evaluation of low-back pain in a child should include a detailed history and a careful physical examination prior to any diagnostic studies. Lead-shielding to protect the gonads from ionizing radiation may obscure a lesion located in the sacrum or the pelvis. | ||
| References | ||
| 1. Lipton G, Riddle E, Grisson L, Fitru T, Marks H, Kumar SJ. An unusual cause of low-back pain in children. A report of two cases. J Bone Joint Surg Am. 2001;83:1552-4. 2. King HA. Back pain in children. Orthop Clin North Am. 1999;30:467-74. 3. Turner PG, Green JH, Galasko CS. Back pain in childhood. Spine. 1989;14:812-4. 4. Bellah RD, Summerville DA, Treves ST, Micheli LJ. Low-back pain in adolescent athletes: detection of stress injury to the pars interarticularis with SPECT. Radiology. 1991;180:509-12. 5. Bradford DS, Garcia A. Herniations of the lumbar intervertebral disk in children and adolescents. A review of 30 surgically treated cases. JAMA. 1969;210:2045-51. 6. DeLuca PF, Mason DE, Weiand R, Howard R, Bassett GS. Excision of herniated nucleus pulposus in children and adolescents. J Pediatr Orthop. 1994;14:318-22. 7. Epstein JA, Epstein NE, Marc J, Rosenthal AD, Lavine LS. Lumbar intervertebral disk herniation in teenage children: recognition and management of associated anomalies. Spine. 1984;9:427-32. 8. Frennered AK, Danielson BI, Nachemson AL. Natural history of symptomatic isthmic low-grade spondylolisthesis in children and adolescents: a seven-year follow-up study. J Pediatr Orthop. 1991;11:209-13. 9. Kazan S, Özdemïr O, Akyüz M, Tuncer R. Spinal intradural arachnoid cysts located anterior to the cervical spinal cord. Report of two cases and review of the literature. J Neurosurg. 1999;91:211-5. 10. Payne WK, Ogilvie JW. Back pain in children and adolescents. Pediatr Clin North Am. 1996;43:899-917. 11. Salminen JJ, Erkintalo MO, Pentti J, Oksanen A, Kormano MJ. Recurrent low back pain and early disc degeneration in the young. Spine. 1999;24:1316-21. 12. Tertti MO, Salminen JJ, Paajanen HE, Terho PH, Kormano MJ. Low-back pain and disk degeneration in children: a case-control MR imaging study. Radiology. 1991;180:503-7. 13. King HA. Evaluating the child with back pain. Pediatr Clin North Am. 1986;33:1489-93. 14. Davis SW, Levy LM, LeBihan DJ, Rajan S, Schellinger D. Sacral meningeal cysts: evaluation with MR imaging. Radiology. 1993;187:445-8. 15. Jarvik JG, Maravilla KR, Haynor DR, Levitz M, Deyo RA. Rapid MR imaging versus plain radiography in patients with low back pain: initial results of a randomized study. Radiology. 1997;204:447-54. |
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