DDX of back pain

Approach to the DDX of back pain: A practical approach by age

  • Prepubertal:
    — Infection – osteomyelitis / diskitis
    — Tumor – spinal column or cord
  • Pubertal:
    — Spondylolysis / spondylolisthesis
    — Scheuermann disease
    — Disc herniation
    — Overuse – mechanical back pain
    — Tumor – spinal column or cord
  • Note: Any of these disease processes can present instead with a limp or failure to bear weight
  • Note: Painful scoliosis should always be investigated with cross-sectional imaging
  • Note: Osteomyelitis / diskitis, Langerhans cell histiocytosis, lymphoma, Ewing sarcoma and osteosarcoma can all have a similar clinical presentation and appearance