Differential Diagnosis for Low Back Pain in a 10-year-old Male

Single Most Likely Diagnosis

• Musculoskeletal strain: This is the most common cause of low back pain in children and adolescents, often resulting from overuse or trauma during sports activities. The age and presentation of 4 weeks of low back pain without additional alarming symptoms make this a plausible first consideration.

Other Likely Diagnoses

• Spondylolysis: A common cause of low back pain in adolescents, especially those involved in sports that include repetitive hyperextension of the spine. It is a defect in the pars interarticularis and can be a precursor to spondylolisthesis.
• Scheuermann's disease: A condition affecting the thoracic or lumbar spine, characterized by kyphosis and back pain, often seen in adolescents.
• Discitis or osteomyelitis: Although less common, these infections can cause back pain in children and are important to consider, especially if there are systemic symptoms such as fever.

Do Not Miss Diagnoses

• Tumor (e.g., osteosarcoma, Ewing's sarcoma): Although rare, spinal tumors can cause back pain and must be considered to avoid delayed diagnosis.
• Inflammatory bowel disease: Conditions like Crohn's disease or ulcerative colitis can have extraintestinal manifestations, including back pain due to associated spondyloarthritis.
• Spinal cord injury or cauda equina syndrome: These are emergencies that require immediate attention. Symptoms can include severe back pain, neurological deficits, and changes in bowel or bladder function.
• Slipped capital femoral epiphysis (SCFE) or hip pathology: While primarily affecting the hip, these conditions can refer pain to the lower back and are important to diagnose promptly to avoid long-term damage.

Rare Diagnoses

• Ehlers-Danlos syndrome: A group of disorders that affect connective tissues supporting the skin, bones, blood vessels, and many other organs and tissues. Defects in connective tissues cause the signs and symptoms of these conditions, which can include back pain.
• Marfan syndrome: A disorder that affects the connective tissue in many parts of the body, which can lead to back pain among other symptoms.
• Spinal epidural abscess: A rare but serious condition that can cause back pain, fever, and neurological deficits, requiring urgent medical attention.

Each of these diagnoses has a different set of implications for treatment and prognosis, highlighting the importance of a thorough evaluation to determine the underlying cause of low back pain in a child.