The aim of this review was to estimate the prevalence of spinal and non-spinal pathologies in children and adolescents seeking care for back pain.
We conducted an electronic search of CINAHL, MEDLINE and EMBASE databases. We included any observational study investigating the prevalence of spinal and non-spinal pathologies in children and adolescents seeking care for back pain. We included studies with children and adolescents up to 24 years old seeking care in a healthcare facility with a complaint of back pain (including acute, subacute, or chronic) at presentation and diagnosis was made with respect to spinal or non-spinal pathology. Spinal pathologies were considered as serious pathologies related to back pain and defined as the specific cause of back pain related to spinal pathologies (e.g., trauma, cauda equina syndrome, infection, tumour). Non-spinal pathology was defined when the cause of pain was not directly related to the spine (e.g., kidney disease, fibromyalgia). Studies investigating children and adolescents seeking care for spinal pain, in general, were included if they reported data separately for children and adolescents seeking care for low back pain. Studies were eligible if they adopted valid approaches for determining the prevalence of spinal and non-spinal pathologies among young people seeking treatment for back pain. Risk of bias of individual studies was evaluated.
A total of 3,323 studies were retrieved on our search. After screening title, abstracts and full texts, 11 studies met our inclusion criteria and were included in this review. The pooled prevalence for the serious pathologies was of 0,9% as trauma (3 studies, n=1923), 9% as spondylolisthesis (2 studies, n=18,873 low quality of evidence), and 0,03% as infections (2 studies, n=75, low quality of evidence). The prevalence for other serious pathologies we found 0,01% as cauda equina syndrome (1 study, n=2, low quality of evidence) and spinal tumour (1 study, n=253, low quality of evidence). The prevalence of non-spinal pathologies (e.g. urinary tract infection; idiopathic; Renal disorders) varied from 5% to 80%.
The prevalence of serious spinal pathologies varied by setting. Differential diagnostic strategies with clear care pathways need to be available to ensure a prompt diagnosis of serious spinal pathologies and non-spinal pathologies.
This study is filling an important gap by systematically reviewing the prevalence of spinal and non-spinal pathologies in children and adolescents seeking care for back pain. Understanding the prevalence of these conditions is essential for developing targeted interventions, improving early diagnosis and management, optimising healthcare resource allocation, and informing public health strategies.
Children
Adolescents
