912 - A Must Not Miss: Pediatric Back Pain

Case Diagnosis: Aneurysmal Bone Cyst

Case Description: 13-year-old male without significant past medical history initially presented to his pediatrician with acute onset of upper back pain and a palpable mass. The patient’s mass was tender and pain worsened with movement such as running. Thoracic Xray's were normal. Over the course of 4 months, the patient developed gait disturbance, lower extremity hyperreflexia and clonus. Orthopedic Surgery ordered an MRI which showed an aneurysmal bone cyst with blood fluid levels with proximal thoracic cord compression at the level of T6. There was expansion into the posterior spinal canal. By this time the patient had decreased lower extremity strength of 3+/5 and decreased lower extremity sensation and numbness.

Discussions: Patient underwent thoracic resection of the ABC, T2-T7 posterior spinal fusion, and T2-T5 laminectomy. Patient experienced post-surgical edema that led to slight bilateral lower extremity numbness and weakness. Patient treated with dexamethasone and improved. Patient’s initial evaluation post op showed max assist for 5 steps bed to chair. By discharge from IPR, the patient was minimum assist with rolling walker for 200 feet but remained wheelchair level for community ambulation.

Conclusions: Pediatric back pain is a rare complaint that presents a broad differential of possibilities. Pediatric back pain tends to improve within two weeks, however, pain lasting longer requires further assessment, imaging, and proper consultation (3). Our patient was found to have an aneurysmal bone cyst which is a rare, vascularized, and extensive benign lytic lesion that should not be overlooked(1,2). Bone cysts occur during skeletal growth, commonly in the first two decades of life (1,2). It is important to know the pediatric back pain “red flags” that prevent missing life-threatening diagnosis which includes tender palpitation, limited range of motion, and bowel and bladder incontinence (3).