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Roger Saldana, MD

Pediatric Orthopedic Surgeon

Baptist Health Medical Group

� Approach to child with spinal/back complaints

� Back pain

� Scoliosis

� Spondylolysis

� Spondylolisthesis

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� Onset

� Trauma

� Constitutional symptoms

� Location

� Neurologic history� Specifically ask about bowel and bladder

� ROS

� Family history

� Visual inspection� General appearance� View from side, and back� Adams forward bend test� Look at feet!

� Range of motion� Flexion� Extension� Rotation

� Palpation� Point tenderness� Step off

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� Motor exam� Walk on toes/heels� Squat� Resist flexion/extension� Resist shoulder abduction

� Neurologic exam� Sensory C4-S1� Reflexes� Babinski� Clonus� Abdominal reflex

� X-rays� Trauma� Night pain� Fever� Pain >6 weeks� Age <8

� Bone Scan� Negative x-rays

� CT� Positive x-ray or bone scan

� MRI� Abnormal neurologic exam� Scoliosis in children <8� Atypical scoliosis

� Blood work� Night pain� Constitutional symptoms

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� Prevalence increasing

� Adolescent incident approaching that of adults

� Age� <5: tumor, discitis

� 5-10: Langerhans cell histiocytosis, tumor, leukemia, discitis

� 10-18: Scheuermann kyphosis, disc herniation or apophysis, spondylolyis, tumor, leukemia

� Coronal curve 10 degrees or greater

� 80% idiopathic

� Rarely causes back pain

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� School/community based

� Adams forward bend test

� Scoliometer

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� Ask the child to slowly bend forward. The examiner should view the child from the back with eyes at the same level as the back.

� Adjust the bending position height so the deformity of the spine is most pronounced.

� Gently lay the scoliometer across the deformity at right angles to the body, with the marking centered over the curve. Observe the scoliometer reading.

� Generally refer if >7

There’s an app for that

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� Age

� During growth spurts

� Double curves

� Thoracic curves

� More severe curves

� Menarche

� Voice change in boys

� Risser sign

� Bone age

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� Pain

� Neurofibromatosis

� Neurologic abnormalities

� Connective tissue disorders

� Left curves

� Foot deformity

� 10-25 degrees

� 25-40

� >40

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� Defect in the pars interarticularis

� Common cause of back pain

� L5 most common location

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� Anterior slippage of vertebral body

� L5 on S1 most common

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� Trauma 50%

� Genetic predisposition

� Repetitive hyperextension

� Gait

� Palpation� Step off

� ROM� Popliteal angles

� Hyperextension

� Neurologic� L5

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� X-rays� Obliques

� Bone scan� Sensitive in acute phase

� Non-specific

� SPECT� Gold standard

� CT

� MRI� Becoming study of choice

� Rest

� Brief course of anti-inflammatory medication

� Lumbar support

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� Failed conservative treatment

� Neurologic symptoms

� Grade 3-4 slips

Thank you

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� Hensinger RN: Back Pain in Children. In Bradfird Ds, Hensinger Rn (eds): The Pediatric Spine. New York,Thieme, 1985, P 41.

� James JI: Idiopathic scoliosis: The prognosis, diagnosis, related to curve pattern at age of onset. J Bone Joint Surg Br 36:36-49, 1954

� Dickson RA: Conservative treatment for idiopathic scoliosis. J Bone Joint SurgBr 67:176-181, 1985

� Izatt MT1, Bateman GR, Adam CJ. Evaluation of the iPhone with an acrylic sleeve versus the Scoliometer for rib hump measurement in scoliosis. Scoliosis. 2012 Jul 30;7(1):14. doi: 10.1186/1748-7161-7-14.

� Fredrickson BE, Baker D, McHolick WJ, et al: The natural history of sponylolysis and spondylolisthesis. J Bone Joint Surg Am 66:699-707, 1984

� Pizzutillo PD, Hummer CD III: Nonoperative treatment of pain in adolescent spondylolysis and spondylolisthesis. J Pediatr Orthop 9:538-540, 1989

� Micheli L: Low back pain in the adolescent : Differential diagnosis. Am J Sports Med 7: 362-364, 1979