- Congenital – tethered cord
- Inflammatory – ankylosing spondylitis, enteropathic arthritis, transverse myelitis
- Infectious – osteomyelitis / diskitis (bacterial, tuberculous), perforated appendicitis, pyelonephritis
- Traumatic – spondylolysis, spondylolisthesis
- Musculoligamentous – disc herniation (herniated nucleus pulposus or apophysis), mechanical back pain
- Neoplastic / bony – aneurysmal bone cyst, osteoid osteoma, osteoblastoma, Langerhans cell histiocytosis, leukemia, lymphoma (Hodgkin, Non-Hodgkin, Burkitt), osteosarcoma, Ewing sarcoma
- Neoplastic / neurogenic – spinal cord tumor (astrocytoma, ependymoma), neuroblastoma
- Developmental – Scheuermann disease
- Psychogenic
Approach to the differential diagnosis 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
Pediatric Imaging 