Feldman D S, Hedden D M, Wright J G
The Hospital for Joint Diseases, New York, New York, USA.
J Pediatr Orthop. 2000 Nov-Dec;20(6):790-5. doi: 10.1097/00004694-200011000-00018.
Children with back pain frequently undergo detailed investigation because of the perception that a high percentage will have a treatable spinal condition. The purposes of this study was (i) to determine the percentage of children with disabling back pain presenting to our institution who had a diagnosis (i.e., to explain their back pain), (ii) to evaluate the clinical markers that should alert clinicians to underlying pathology, (iii) and to determine the prognosis of children with back pain and no specific diagnosis. This study was a retrospective analysis of consecutive children undergoing single-photon emission computed tomography for a primary complaint of back pain. Data collection included chart review, radiographic analysis, and clinical follow-up with the Roland and Morris scale for pain and disability. Two hundred and seventeen patients with an average age of 13 years (range, 2.7-17.7) were reviewed on average 4.4 years after presentation (range, 1.1-7.2 years). One hundred and seventy children (78.3%) had no specific diagnosis to explain their back pain, 15 children (6.9%) had spondylosis, 10 children (4.6%) had tumor, and the remaining 22 children (10.1%) had various diagnoses including infection, Scheuermann's kyphosis, herniated disc, kidney disease, facet arthritis, degenerative disc disease, congenital anomalies, and tethered cord. Factors associated with positive diagnoses were constant pain and male gender. Night pain, constant pain, and duration of symptoms <3 months were associated with the diagnosis of a tumor. Although the majority of children presenting with persistent back pain had no demonstrable cause, of 132 contactable patients 94 (71%) had persisting pain at the time of clinical follow-up. In conclusion, the majority of children with disabling back pain has no demonstrable cause and the majority will continue to have pain years after initial presentation.
由于人们认为很大比例的背痛儿童会患有可治疗的脊柱疾病，因此背痛儿童经常接受详细检查。本研究的目的是：（i）确定在我们机构就诊的患有致残性背痛的儿童中已确诊（即能解释其背痛原因）的比例；（ii）评估应提醒临床医生注意潜在病理状况的临床指标；（iii）确定背痛且无明确诊断的儿童的预后情况。本研究是对因背痛主诉接受单光子发射计算机断层扫描的连续儿童进行的回顾性分析。数据收集包括病历审查、影像学分析以及使用罗兰和莫里斯疼痛与残疾量表进行临床随访。对平均年龄为13岁（范围2.7 - 17.7岁）的217例患者在就诊后平均4.4年（范围1.1 - 7.2年）进行了复查。170名儿童（78.3%）没有明确诊断来解释其背痛，15名儿童（6.9%）患有脊椎关节病，10名儿童（4.6%）患有肿瘤，其余22名儿童（10.1%）有各种诊断结果，包括感染、休门氏驼背、椎间盘突出、肾脏疾病、小关节关节炎、椎间盘退变疾病、先天性异常和脊髓栓系。与确诊相关的因素是持续性疼痛和男性性别。夜间疼痛、持续性疼痛以及症状持续时间<3个月与肿瘤诊断相关。尽管大多数出现持续性背痛的儿童没有可证实的病因，但在132名可联系到的患者中，94名（71%）在临床随访时仍有持续性疼痛。总之，大多数患有致残性背痛的儿童没有可证实的病因，并且大多数在初次就诊数年之后仍会持续疼痛。
