The Pain Is “Knot” Getting Better: Case of a Girl with a “Knot in the Back”. Back Pain Due to an Aneurysmal Bone Cyst

Abstract

Back pain in children is common and, although rare, can be associated with a number of pathologic processes. A detailed history of the back pain and careful physical exam can often reveal details that allow the physician to determine if the back pain is benign or possibly secondary to an underlying condition. While mild pain can be present for some time, it is not uncommon for children with back pain to present for the first time following a traumatic event. In these cases, it is especially important to determine the course of the back pain, as the history may reveal long-standing pain with an acute change after the trauma. Patients presenting with “red flag” signs and symptoms and those with acute changes in the back pain after a traumatic event require more urgent evaluation. Basic radiographic evaluation demonstrating changes in the vertebral body or destruction of the bony radiographic landmarks in the spine should lead to emergent further evaluation, as these issues often are caused by more aggressive processes associated with pathologic bone disease. Benign but locally aggressive bony spinal tumors, such as aneurysmal bone cysts, are uncommon in children and can lead to pain and eventually pathologic instability of the spine which are at risk for pathologic spine fractures with even minor trauma. As such, early detection of these lesions is imperative to avoid secondary spinal injury, and complete surgical resection is needed to avoid recurrence of the lesion.