Thoracic back pain in children

The most common cause of thoracic back pain in children is 'postural backache', also known as 'TV backache', which is usually found in adolescent schoolgirls and is a diagnosis of exclusion. Important, although rare, problems in children include infections (tuberculosis, discitis and osteomyelitis) and tumours such as osteoid osteoma and malignant osteogenic sarcoma. Dysfunction of the joints of the thoracic spine in children and particularly in adolescents is very common and often related to trauma such as a heavy fall in sporting activities or falling from a height, e. g. off a horse. Fractures, of course, have to be excluded.

Inflammatory disorders to consider are juvenile ankylosing spondylitis and spinal osteochondritis (Scheuermann's disorder), which may affect adolescent males in the lower thoracic spine (around T9) and thoracolumbar spine. The latter condition may be asymptomatic, but can be associated with back pain, especially as the patient grows older. It is the commonest cause of kyphosis. It is important to screen adolescent children for idiopathic scoliosis, which may be without associated backache.

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