1. BACKACHE IN ADOLESCENCE BLOCK 14

2. WHAT’S SPECIAL

3. Extent of the problem (Nachemson)
Affects 80% of people
Self – limiting disease
70% clears spontaneously in 2-3 weeks
90% clears with conservative treatment in 6-8 weeks
<5% will need surgery

4. CAUSES
Mechanical
Pathological

5. Causes of low backpain Trauma - fractures(esp. pathological) - sprains
Infections –acute discitis
- tuberculosis
Tumours primary( myeloma)
-secondary(breast , lung , thyroid , renal,
prostate)
Degeneration oa of the 3-joint complex
-disc herniation
Refered from abdomen - pancreas ,kidneys ,aorta ,
uterus
Psychosocial factors

6. TREATMENT

7. Clinical assessment
History
Examination
Investigations

8. Red Flags Age <15; >50 Duration >1mnth History of cancer
Loss of weight
Rest pain
Night pain
Fever
Morning stiffness

9. examination Watch patient walk Note ease of getting onto exam table
Assess abdomen
Is tenderness ellicited in abd same as the pain patient presents with
Examine the hips
Neurologic examination
Examination of the back

10. Examination of the back
Deformity
Gibbus
Tenderness
Movement/ stiffness

11. Red Flags Any neurologic deficit -saddle numbness
-urinary incontinence
-urinary retention
Radicular pain
Stiff back

12. TREATMENT
Disease specific

13. Causes in adolescence Infection - Acute discitis - Tuberculosis
Tumours - osteoid osteoma
Trauma - spondylolysis
Scheurmann’s diseases

14. Pathology
Clinical examination
Investigation
Treatment

29. Backache in children should always be regarded
as pathological