Low Back Pain in Adolescents: A 1-Year Analysis of Eventual Diagnoses.

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Low Back Pain in Adolescents: A 1-Year Analysis of Eventual Diagnoses.
Key Take-Away: 

Low back pain (LBP) is a very common problem affecting almost every second individual, but the cause of LBP still remains unidentified. The authors in this study have addressed this huge area of interest and were able to evaluate the underlying causes of low back pain.

Back pain in adolescents is very common and often seen in the office for evaluation of potential spinal pathology.

ABSTRACT: 
Background: 

Back pain in adolescents is very common and often seen in the office for evaluation of potential spinal pathology.

Pediatric back pain has thought to be from serious identifiable causes such as spondylolysis, spondylolisthesis, tumor, or infection. A follow-up analysis of adolescents initially presenting with back pain to their eventual subsequent diagnosis within 1 year has not been reported on a large scale with a national sample.

Methods: 

A national insurance database (Pearl Diver Patient Records Database) was queried for  International Classification of Diseases (ICD-9) codes to identify patients aged 10 to 19 years with back pain from 2007 to 2010.

These patients were tracked for imaging obtained, and eventual development of subsequent associated spinal pathology diagnoses using Current Procedural Terminology (CPT) and ICD-9 codes for up to 1 year after initial presentation.

Results: 

A total of 215,592 adolescents were identified presenting with LBP from 2007 to 2010.

Over 80% of adolescents with LBP had no identifiable diagnosis within 1 year. The most common associated subsequent diagnoses were lumbar strain/spasm (8.9%), followed by scoliosis (4.7%), lumbar degenerative disk disease (1.7%), and lumbar disk herniation (1.3%). The rates of all other diagnoses including spondylolysis, spondylolisthesis, infection, tumor, and fracture had <1% association with LBP.

Conclusion: 

In conclusion, adolescent LBP is a common diagnosis for which underlying serious pathology is rare.

The most common diagnosis aside from strain or muscle spasm associated with LBP is scoliosis and degenerative disk disease. Pediatric orthopaedists often are consulted on patients with LBP and should always have high suspicion for potential serious spinal pathology, but should recognize the most common etiologies of back pain in adolescence.

J Pediatr Orthop. 2015 Sep 11
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