J M Gennari1, C Themar-Noel2, M Panuel3, B Bensamoun4, C Deslandre5, A Linglart6, M Sokolowski7, A Ferrari2. 1. Service de chirurgie infantile, hôpital Nord, Marseille, France. Electronic address: jean-marie.gennari@ap-hm.fr. 2. Service d'orthopédie pédiatrique, hôpital Robert-Debré, Paris, France. 3. Service de radiologie, hôpital Nord, Marseille, France. 4. CNRS, Compiègne, France. 5. Service de rhumatologie, immunologie et hématologie pédiatriques, hôpital Necker, enfants malades, Paris, France. 6. Service d'endocrinologie et diabétologie pédiatrique, hôpital Kremlin-Bicêtre, Paris, France. 7. Service de pédopsychiatrie, hôpital Sainte-Marguerite, Marseille, France.
Abstract
INTRODUCTION: Ten to twenty percent of persons experience spinal pain during growth. Causes are diverse in adolescents, and it is essential to determine etiology rapidly so as to guide optimal management. HYPOTHESIS: It is important for the pediatric orthopedist to understand the natural history of conditions inducing spinal pain. MATERIAL AND METHODS: A retrospective study included 116 adolescents presenting with spinal pain at the Hôpital Nord (Marseille, France) between January 1, 2009 and January 1, 2014. Malignant tumoral etiologies were excluded. Mean patient age was 13.6 years. Risser ranged between >0 and <5. Interview and clinical examination (skin, spine, neurologic examination, general clinical examination) were systematic; depending on results, complementary examinations (imaging, biology, biopsy) were prescribed. RESULTS: There were 32 cases of non-specific adolescent low back pain, 31 of lumbar or thoracolumbar scoliosis, 23 of spinal growth dystrophy (Scheuermann's disease), 13 of isthmic lysis, 5 of spondylolisthesis, 8 of transitional lumbosacral hinge abnormality, 2 of discal hernia, 1 of osteoid osteoma and 1 of eosinophil granuloma. Treatment was often non-operative when diagnosis was sufficiently early. In case of failure, surgery could generally be considered. DISCUSSION: Correctly indicated non-operative management or surgery changes the natural history of these pathologies. The aim of treatment is to resolve pain in adolescence, as it risks becoming chronic and disabling by adulthood.
INTRODUCTION: Ten to twenty percent of persons experience spinal pain during growth. Causes are diverse in adolescents, and it is essential to determine etiology rapidly so as to guide optimal management. HYPOTHESIS: It is important for the pediatric orthopedist to understand the natural history of conditions inducing spinal pain. MATERIAL AND METHODS: A retrospective study included 116 adolescents presenting with spinal pain at the Hôpital Nord (Marseille, France) between January 1, 2009 and January 1, 2014. Malignant tumoral etiologies were excluded. Mean patient age was 13.6 years. Risser ranged between >0 and <5. Interview and clinical examination (skin, spine, neurologic examination, general clinical examination) were systematic; depending on results, complementary examinations (imaging, biology, biopsy) were prescribed. RESULTS: There were 32 cases of non-specific adolescent low back pain, 31 of lumbar or thoracolumbar scoliosis, 23 of spinal growth dystrophy (Scheuermann's disease), 13 of isthmic lysis, 5 of spondylolisthesis, 8 of transitional lumbosacral hinge abnormality, 2 of discal hernia, 1 of osteoid osteoma and 1 of eosinophil granuloma. Treatment was often non-operative when diagnosis was sufficiently early. In case of failure, surgery could generally be considered. DISCUSSION: Correctly indicated non-operative management or surgery changes the natural history of these pathologies. The aim of treatment is to resolve pain in adolescence, as it risks becoming chronic and disabling by adulthood.
Authors: Elena Amăricăi; Oana Suciu; Roxana Ramona Onofrei; Roxana Steliana Miclăuș; Radu Emil Iacob; Liliana Caţan; Călin Marius Popoiu; Simona Cerbu; Eugen Boia Journal: J Int Med Res Date: 2019-12-31 Impact factor: 1.671