Evaluation and Treatment of the Child with Acute Back Pain

Back pain is common, estimated in up to 30% of children, and increasing with age; 80% is benign, mechanical type, improving within 2 weeks of conservative care. An in-depth evaluation often including MRI, laboratory, and specialty care consultations is required if symptoms do not improve or worsen. Spondylolysis and spondylolisthesis comprise almost 10% of pediatric back pain, often caused by lumbar hyperextension activities and treated most commonly with conservative care. Osteoid osteomas and osteoblasto-mas, together, constitute the most common benign spinal tumors in childhood. Aggres-sive and malignant tumors of the spine are rare, but when present, require tertiary care referral and a comprehensive oncology team for optimal life-sustaining outcomes.