Description

Any condition causing pain of the thoracic, lumbar, or sacral spine

Epidemiology

• 12-month period prevalence: 10–20% of children
• Lifetime prevalence: 12–50%

Pathophysiology

• Dependent on underlying cause
• Until skeletal maturity, partially ossified posterior column and vertebral body are weak points.
• Hyperextension with rotational spinal loading in the case of pars defects (e.g., spondylolysis or spondylolisthesis)
• Autoimmune or autoinflammatory processes as with juvenile idiopathic arthritis (JIA) or juvenile ankylosing spondylitis

Etiology

• Unidentified in 50% of cases
• 30% of chronic cases (back pain >3 years) without clear etiology despite workup

Risk Factors

• Poor conditioning or high athletic performance
• Joint hypermobility
• Role of backpack weight and style of wear undetermined
• Role of overweight or obesity yet to be determined

General Prevention

• Back muscle strengthening and hamstring stretching exercises may be helpful.
• Maximum backpack load: 10–15% body weight
• Weight loss and increased physical activity in overweight or obese children
• 3 months off from sport per year, 1 day off from scheduled activity per week