The causes of back pain in children and adolescents will be reviewed here. The epidemiology and evaluation of back pain in children are discussed separately. (See "Evaluation of the child with back pain".)
Benign musculoskeletal disease and trauma account for most cases of back pain in children and adolescents. Other causes, including congenital and acquired conditions such as trauma, infection, inflammatory disease, and neoplasm, which have different implications for treatment or prognosis, also must be considered (table 1 and table 2).
In most large published series, including those from referral centers, the majority of children with back pain receive no definitive diagnosis [1-4]. Nonspecific musculoskeletal pain accounts for at least 50 percent of cases [2-5].
The frequency of specific causes depends upon the population studied. In a prospective series of 73 children presenting to a specialty hospital with back pain for more than three months, excluding children with a history of back surgery, only 13 patients (18 percent) received a definitive diagnosis: spondylolysis with or without spondylolisthesis (nine patients), Scheuermann kyphosis (two patients), osteoid osteoma (one patient), and lumbar disc herniation (one patient) . Among children who present to the emergency department, common causes of back pain include trauma (25 percent), muscle strain (24 percent), sickle cell crisis (13 percent), idiopathic (13 percent), urinary tract infection (5 percent) and viral illness (4 percent) .
Musculoskeletal back pain may be related to muscles, bones, or discs, each with characteristic features .