Imaging of Back Pain in Children and Adolescents Nabil J. Khoury, MD, Mukbil H. Hourani, MD, Mohammad M.S. Arabi, MD, Faysal Abi-Fakher, MD, and Maurice C. Haddad, MD, FRCR Purpose: To present the imaging findings of the wide spectrum of musculoskeletal diseases causing back pain in children and adolescents. Discussion: Back pain in children is a rare condi- tion but may denote a serious health problem; hence, full clinical history, physical examination, and appropriate labo- ratory studies should be obtained. In this scientific exhibit, we present the imaging findings of the variable musculoskeletal diseases that are associated with back pain in children and adolescents. These disease processes include scoliosis of var- ious causes; spondylolysis; spondylolisthesis; traumatic inju- ries; disc degeneration and herniation; Scheuermann’s dis- ease; spondylodiscitis; tumors (primary, secondary, hematogenous); and miscellaneous conditions (eg, metabolic disorders, sickle cell disease, osteoporosis). Conclusion: A wide spectrum of diseases causing back pain in children is presented. Radiologists should be aware of the imaging findings of this rather uncommon entity to help in reaching the appropriate diagnosis. Back pain in the pediatric age group is a rare clinical presentation and is significantly less common than in adults. In the absence of traumatic insult, back pain in children and adolescents frequently denotes serious underlying disease; hence, careful and thorough inves- tigation should be performed by clinical, laboratory, and imaging examinations. In this pictorial review we will discuss and present the imaging findings of variable diseases that cause back pain in children and adolescents. The diseases are categorized in Table 1 and include the following: (1) various traumatic injuries; (2) diseases secondary to specific growth disturbance such as disc degeneration, nontraumatic spondylolisthesis, Scheuermann’s dis- ease, scoliosis; (3) progressive diseases such as infec- tions, inflammations, benign and malignant neoplasia (both primary and secondary), bone marrow infiltra- tive tumors; (4) chronic or systemic diseases including hematological and metabolic diseases. Relevant imag- ing findings are summarized in Table 2. Diseases related to the nervous system (eg, spinal cord lesions) will not be discussed in this article. From the Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon. Reprint requests: N. J. Khoury, MD, Department of Diagnostic Radiology, American University of Beirut Medical Center, PO Box 113-6044 Beirut, Lebanon. E-mail: nk01@aub.edu.lb. Curr Probl Diagn Radiol 2006;35:224-44. © 2006 Mosby, Inc. All rights reserved. 0363-0188/2006/$32.00 + 0 doi:10.1067/j.cpradiol.2006.07.007 TABLE 1. Classification of diseases causing back pain in children and adolescents A. Traumatic 1. Mechanical or sports injury 2. Discogenic herniation 3. Traumatic spondylolysis and secondary spondylolisthesis 4. Ring apophyseal fracture B. Diseases related to growth disturbance 1. Disc degeneration 2. Spondylolysthesis without spondylolysis 3. Scoliosis 4. Scheuermann’s disease C. Infections/Inflammation 1. Tuberculous 2. Nontuberculous 3. Inflammatory spondyloarthropathy D. Neoplastic disorders 1. Benign a. Osteoid osteoma b. Osteoblastoma c. Aneurysmal bone cyst 2. Malignant a. Langerhans cell histiocytosis b. Osteosarcoma c. Ewing’s sarcoma d. Leukemia e. Lymphoma f. Metastases E. Hematological disorders 1. Sickle cell disease F. Metabolic disorders 1. Osteoporosis 2. Alkaptonuria G. Miscellaneous 1. Osteopetrosis 224 Curr Probl Diagn Radiol, November/December 2006