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Virtual Pediatric Hospital: Back Pain in Children: Case Examples of Back Pain in Children: Case 4 Back Pain in Children: Case Examples of Back Pain in Children

Case 4

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed


15 year old male with low back pain and bilateral radicular pain for 5 months with no history of trauma. He had paresthesias over the anteromedial calves in an L4 distribution, and had no bowel or bladder dysfunction. His physical exam was remarkable for a positive straight leg raise bilaterally to 45 degrees. His laboratory values were unremarkable. Clinically he was felt to have a herniated disk.

Plain films of the lumbar spine (not provided) were unremarkable.

case 4: image 1 iconImage

A diagnosis of herniated disk was made, and the patient was treated with strict bed rest and pelvic traction for several weeks. He was then put into a back brace and showed continued improvement.

Herniated disks are rare in prepubertal children, but are increasing in incidence in adolescents as more and more undertake competitive sports. It occurs after an exertion and is traumatic in nature, unlike herniated disks in adults which are degenerative in nature. Herniated disks in adolescents are larger than those in adults because adolescents have a small tear in a health annulus, causing a large amount of disk tissue to extrude. Plain films of the spine are unremarkable. A MRI exam will show an asymmetric extradural defect on the thecal sac.

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