Differential Diagnosis for Bilateral Back Pain in Adolescents
Single Most Likely Diagnosis
- Musculoskeletal strain: This is the most common cause of back pain in adolescents, often due to overuse, poor posture, or sports-related injuries. The bilateral nature of the pain could be related to activities that involve repetitive strain on both sides of the back.
Other Likely Diagnoses
- Scoliosis: A common condition in adolescents that can cause back pain, especially if the curvature is significant. The pain can be bilateral, depending on the type and severity of the scoliosis.
- Spondylolysis or spondylolisthesis: These conditions involve defects in the vertebrae and can cause back pain, often bilateral, due to instability or stress on the spine.
- Idiopathic back pain: A diagnosis of exclusion, where no specific cause for the back pain can be identified. It's common in adolescents and can be bilateral.
Do Not Miss Diagnoses
- Spinal infection (e.g., osteomyelitis, discitis): Although rare, spinal infections can cause severe back pain and have serious consequences if not treated promptly. The pain can be bilateral and is often accompanied by systemic symptoms like fever.
- Tumor (e.g., osteosarcoma, Ewing's sarcoma): Tumors of the spine can cause back pain, which may be bilateral, and are critical to diagnose early due to their potential for serious morbidity and mortality.
- Inflammatory conditions (e.g., ankylosing spondylitis): Conditions like ankylosing spondylitis can cause chronic back pain and stiffness, often bilateral, and have significant implications for long-term health if not managed properly.
Rare Diagnoses
- Scheuermann's kyphosis: A condition that affects the thoracic spine, leading to kyphosis (a rounded back). It can cause back pain, which might be perceived as bilateral, especially if the kyphosis is significant.
- Osteogenesis imperfecta: A genetic disorder that affects the bones, making them fragile. It can lead to back pain due to fractures or deformities of the spine, potentially causing bilateral pain.
- Ehlers-Danlos syndrome: A group of disorders that affect connective tissues, which can lead to musculoskeletal symptoms, including back pain. The pain can be bilateral due to the widespread nature of the condition.