General Diagnostic Approach To Adolescent With Back Pain

Back pain in the adolescent is less likely to represent a serious problem compared to the younger child, and less likely compared to adults to represent spinal pathology compared to adults. Therefore, the majority of adolescents with back pain will have a mild, self-limited problem and will not need an extensive work-up. A careful history and physical exam should distinguish nonspecific back pain from more serious etiologies. Figure 3 is one algorithmic approach to back pain diagnosis. In general, an urgent evaluation is required in an adolescent with neurological signs and symptoms suspicious of a possible or impending spinal cord compression as can occur with tumor, epidural abscess, or fracture. Plain radiographs are indicated in those assessed to be likely to have a problem associated with radiographic changes or with a history of significant trauma prior to back pain onset. MRI is best for further investigation of a significant plain radiographic abnormality, or in those who have serious or persistent symptoms. Laboratory studies, such as CBC, comprehensive serum chemistry screening, urinalysis, ESR, CRP, should be done in those suspected of having a systemic problem. If a rheumatic condition is suspected, then depending on what is suspected, tests such as HLA-B27 (in ERA), ANA (lupus), ANCA, and/or ASCA (IBD) may be helpful.

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