Back pain in children is rare, most often during periods of intensive growth and is not that much of a concern. Therefore, when a child complains of more severe back pain that does not go away within a few days, the problem should not be taken lightly.
Back pain is a common symptom in sedentary adults. It occurs rarely in children, most often during periods of intensive growth and is not so worrisome. Therefore, when a child complains of more severe back pain that does not go away within a few days, the problem should not be taken lightly.
What can cause back pain in a child?
Back pain in children can have the same causes as in adults: minor or more serious injuries, overloading the back with a heavy backpack or bag, incorrect posture while sitting and slouching. In these cases, tension in the back muscles and intervertebral joints causes unpleasant pain.
Pain can be caused by congenital or acquired defects in posture and structure of the back, when curved vertebrae irritate neighboring nerves.
But the cause of the illness can be much more serious. Back pain in children can be a nonspecific symptom of developing infections, kidney disease, and even cancer.
Do not delay visiting your doctor if, in addition to back pain, you experience fever, digestive tract upset, wet sweat, or cramps.
An X-ray, magnetic resonance imaging, or CT scan can help diagnose the cause of the pain.
What are the most common back problems in children?
The three most common back defects in children and adolescents are called scoliosis, kyphosis, and lordosis.
Scoliosis is a lateral curvature of the spine. Kyphosis looks like a hump or round back because the spine is too far back in the thoracic region. Lordosis, in turn, is associated with a forward curve of the spine in the lumbar region.
The causes of the disorders often lie in persistent poor posture while sitting, excessive back strain due to lifting heavy objects or carrying bags on one shoulder. Defects can also be congenital or result from disease or a diet low in calcium and vitamin D3. Most often they appear during a period of intensive growth.
What are the consequences of back deformation?
Back deformation is not only an aesthetic problem.
The spine is the support of the whole body, it is the support of the chest, so it affects the functioning of most organs. A curved spine is not only a source of pain. This limits the child's physical capabilities and can cause nervous system disorders. Back weakness causes problems with breathing, heart function and can lead to permanent disability.
For mild postural problems, corrective exercises or rehabilitation are sufficient. More severe cases may require an orthopedic brace and even surgery to correct the curvature of the spine.
Diagnostics
If pain occurs after exercise, or during sports, you should consult a doctor and rule out injury. To do this, the specialist will conduct an external examination, prescribe laboratory tests and various instrumental diagnostic procedures. These include:
- X-ray. A simple, fast and most informative method in the presence of a spinal injury or a degenerative process in bone tissue. With its help, you can detect scoliosis or other pathological processes in a child’s body in a timely manner.
- Ultrasound of internal organs. Prescribed for suspected pathological processes in the uterus, ovaries, kidneys or intestines. The study is simple and painless and allows you to diagnose or exclude a number of dysfunctions of internal organs.
- MRI. Prescribed for suspected inflammatory process in soft tissues. With its help, you can detect even minor changes, tumors, problems in muscles or ligaments, and bone marrow lesions in a timely manner.
- Scintigraphy. This functional imaging technique makes it possible to examine the organs of the urinary system and is prescribed only if a malfunction of the pelvic organs is suspected.
- Electromyography. A diagnostic procedure that allows you to evaluate the general condition of skeletal muscles and peripheral nerves. Prescribed to determine the nature of damage to muscle tissue and nerve fibers.
Laboratory tests of urine and blood can exclude the presence of an inflammatory process in the soft tissues and the general health of the patient. An increased level of leukocytes in the urine allows one to suspect an infectious process.
During the examination, it is important to determine the general condition of the musculoskeletal system, the presence of spinal dysfunction, and the mobility of its individual segments. To do this, tests are carried out in a lying and sitting position, various reflexes are checked.
A cold compress can help temporarily relieve pain.
How to prevent back pain in a child
- Monitor the correct posture of the child in the first months of his life. Place your baby on his tummy as lifting his head exercises and strengthens his back muscles.
- Avoid too soft a mattress and high pillows for your baby.
- Take care of proper nutrition. During the growth and development of the skeletal system, calcium and vitamin D should not be missed, so the daily menu should be rich in dairy products (milk, cheese, yogurt), lean meat, vegetables and fruits. Flavored calcium syrups can be used to replenish lime deficiency, and tablets in soluble form can be offered to older children. It is recommended that breastfed infants receive 10 mcg of vitamin D. This amount corresponds to one vitamin D3 oil capsule, which can be squeezed directly into the baby's mouth or added to food.
- A proper diet will ensure proper mineralization of bones and development of teeth, and will also prevent the development of rickets.
- Encourage your child to be physically active. The best workout for your back is swimming. In water, the body is less vulnerable to injury and all parts of the muscles are used.
- Try exercising your child's back muscles several times a week. Carrying a book on your head or pressing your torso against your cat's back can be fun.
- School period is a big challenge for the back. Choose a suitable backpack that hugs your child's entire back rather than hanging on his shoulders or butt. The backpack should have a rigid back and wide adjustable straps. Make sure your child wears the backpack on both shoulders.
- Make your child sit at the table in a comfortable position. Provide him with a height-adjustable chair with a concave backrest at the level of the lumbar spine. In order to develop an upright body in a child, you can use the so-called spider. This simple harness attaches to your child's back. The spider forces the shoulder blades back and the chest to push forward. When a child slouches, the hearing aid suggests straightening the back.
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Inflammation of the intervertebral disc (possible diagnoses are discitis, spondylodiscitis, intervertebral osteochondritis, etc.) in adults usually develops as a complication of discectomy. In children it occurs after hematogenous infection and trauma.
Intervertebral discitis in a child was first described by L. Mayer in 1925. The disease has long been considered a “low-destructive”, favorable form of spinal osteomyelitis.
There is little information in the domestic literature about discitis in childhood, and the absence of characteristic clinical manifestations gives rise to a lot of diagnostic errors, which result in incorrect treatment.
The age of children with diskitis is from 1.5 to 15 years; Usually 4–10 year olds are affected, and boys are more likely to get sick. The parts of the spine that are inflamed are: cervical - 56.3%, thoracic - 18.7%, lumbar and lumbosacral - 25%. A double level of disc damage is possible.
The average duration of illness before hospitalization is 10–14 days. The development of discitis can be preceded by infections and injuries, often not related to the affected area. Referral diagnoses: cervical lymphadenitis, spinal osteomyelitis, coxitis, persecution, radiculitis, acute appendicitis, etc. In many children, the spine is not examined.
The etiology of intervertebral discitis in childhood is not fully understood. Most authors adhere to the infectious nature of the disease and previous injury. In cultures from the disc space, S. aureus (most often), S. epidermidis, Kingella, Salmonella spp. are isolated in 30% of observations. and etc.; 70% of crops are sterile. Injury promotes the release of tissue enzymes from the disc, including phospholipase A2, a potential stimulator of inflammation in vitro.
In half of the children with discitis, anomalies are detected: fusion of the vertebrae or an additional vertebra, lumbarization of SI, spina bifida, etc. With malformations of the vertebrae, an increased load is created above and below the affected segment, and this is a predisposing factor for discitis. Confirmation of this is the more frequent localization of intervertebral discitis in the most mobile parts (cervical and lumbar).
The intervertebral disc of the embryo is well supplied with blood: it receives nutrition from the vessels of the periosteum, axial chord and vertebral body. The reduction of the supplying vessels of the disc begins from the moment of birth and is completed by the third decade of life, which explains the significant frequency of discitis in children. Microorganisms penetrate the intervertebral disc hematogenously through terminal vessels on the periphery of the disc in the annulus fibrosus zone or by direct spread of pathogens from the endplates of the adjacent vertebral bodies.
A biopsy of the affected discs shows signs of acute or chronic inflammation. Due to the degradation of the protein-polysaccharide complex of the intracellular matrix of the disc and the loss of the ability to bind water, the intervertebral space narrows. The compaction of the collagen plate of the annulus fibrosus limits its mobility and reduces the mobility of the spine.
But the doctor “didn’t see my back”
Intervertebral discitis develops gradually and is characterized by a mild course. The child sees a specialist 2–3 weeks after the onset of the disease, or even later. Clinical picture: irritability, lameness, reluctance to stand, sit or walk. Older children complain of vague pain in the neck, back, lower back, abdomen, legs (when lifting weights, they intensify in the back). The kids say their stomach hurts. Possible bloating and constipation. Unfortunately, despite the rigidity of the torso, scoliosis and antalgic posture due to spasm of the paravertebral muscles, the back does not attract the doctor’s attention.
There are several syndromes. Inflammatory - characterized by fever and signs of intoxication. Painful - the child talks about pain in the neck, back, lower back. In this case, unpleasant sensations do not always correspond to the location of the affected disc. Statodynamic syndrome - lameness, reluctance to stand, sit or walk. Reflex-tonic - the tone of the cervical (torticollis) and paraspinal muscles is increased, the physiological curves of the spine are reduced or eliminated, and scoliotic deformity appears (antalgic posture). Abdominal - caused by inflammation of the intervertebral discs of the lower thoracic and lumbar regions; The muscles of the anterior abdominal wall periodically tense, defecation is painful, and bloating is possible. Neuropathic - develops due to involvement of the roots of the cervical, brachial, lumbar or sacral plexus; characterized by disorders of sensory fibers. Discitis of the cervical spine from CI to CIV (cervical plexus) is manifested by neuritis n. occipitalis minor, nn. supraclavicularis, n. accessorius, etc. Discitis from CIV to TI (brachial plexus) - neuritis n. subclavius, nn. thoracales anteriores et posteriores, n. supraclavicularis, nn. subscapulares, etc. With inflammation of the lumbar discs (lumbar plexus), neuritis n. may develop. iliohypogastricus, n. cutaneus femorlis lateralis, n. femoralis, etc. With discitis of the lumbosacral region (sacral plexus) there are signs of neuritis n. isciadicus, n. piriformis, n. quadratus femoris, n. gluteus superior et inferior, etc. It is the detection of neuropathic syndrome that helps in the topical diagnosis of discitis.
Young children often have inflammatory, statodynamic and abdominal syndromes, while older children have pain, statodynamic, reflex-tonic and neuropathic syndromes. At the onset of intervertebral discitis, body temperature rises to 38.0°C. The condition of most children is moderate.+
Discitis of the cervical spine is characterized by pain, forced head position (symptomatic torticollis), flattened lordosis and tension in the neck muscles. When there is a load on the head, half of the children in the affected area have a pain reaction. It is also detected in the projection of the spinous processes and paravertebral points at the level of the affected and adjacent segments. Neck pain is relieved by holding the head with your hands. Sometimes there are meningeal signs. All children have enlarged, moderately painful lymph nodes of the neck, although there are no inflammatory changes in the oropharynx.
Discitis of the thoracic spine causes back pain. When localized in the upper thoracic region, they are encircling in nature and intensify with inspiration (symptomatic intercostal neuralgia). If the focus of inflammation is in the lower thoracic region, abdominal pain and rigidity of the lumbar spine are noted.
In the clinical picture of discitis of the lumbar and lumbosacral spine, pain also comes to the fore. It is in the lower back, abdomen, sometimes in the buttocks, thighs, hip and knee joints; lameness is observed. Children can stand; squat; stand up - but at the same time the lumbar spine is rigid. Lateral bending of the body is limited; it is impossible to bend forward. Sometimes patients refuse to walk and lie in a forced position on their back; as soon as they try to change it, they feel pain in the lower back. There is a smoothness of the lumbar lordosis, tension in the long muscles of the back, scoliosis, pain in the spinous processes and paravertebral at the level of the affected segment.
When sitting in bed, children prefer to lean on their hands. There may be a decrease in abdominal reflexes, the presence of Wasserman, Matskevich, Lasegue symptoms, instability of the knee and Achilles reflexes, and abdominal pain. Sometimes Govers' symptom is detected: a child lying prone, rising to his feet, takes a knee-elbow position; standing up, he sequentially grabs his shins, knees and thighs with his hands. Active movements in the hip and knee joints are limited, only passive ones are preserved.
With LV-SI discitis, painful urination occurs, and with inflammation of the SI-II disc space, pain is felt during bowel movements.
In the blood - moderate leukocytosis, an increase in the leukocyte index of intoxication, an increase in ESR to 40 mm/h and an increase in the level of acute-phase proteins (CRP, ceruloplasmin, seromucoids). Half of the patients have dysproteinemia and dysgammaglobulinemia. Blood culture is usually negative.
What will an x-ray show?
During X-ray examination, the decisive diagnostic sign of discitis is narrowing of the intervertebral space. There are four phases of radiological manifestations of discitis.
Phase 1 (1–2 weeks from the onset of the disease). The spondylogram shows smoothness of the physiological curves of the spine according to the level of the lesion. In approximately half of the cases there are congenital anomalies of the spine: fused and accessory vertebrae (in the cervical region), lumbarization SI, spina bifida, etc.
Phase 2 (3–4 weeks). The height of the intervertebral space decreases, sometimes accompanied by osteoporosis of the adjacent vertebral bodies. As a rule, there is a narrowing of one disk space (sometimes a double lesion). With discitis in the cervical spine, minimal antelisthesis and vertebral instability are possible.
Phase 3 (5–10 weeks). Erosion of the endplates of the adjacent vertebral bodies and a more noticeable narrowing of the disc space.
Phase 4 (11–16 weeks). The narrowing continues, and sclerosis of the vertebral endplates develops.
Irritation of the growth zones of the contacting vertebra can enlarge its body (vertebra magna), change its shape (trapezoidal, decreased height, spinous growths). In older children, when a disc ruptures, there is a risk of adhesions forming between the vertebral bodies.
CT has a higher resolution compared to radiography and detects a narrowing of the disc space in the second week, and also reveals erosion of the endplates, destructive changes in the disc and areas of subchondral sclerosis of adjacent vertebrae. In addition, this study visualizes the configuration, size of the spinal canal, tumors, hematomas, etc. The disadvantage of the method is some limitations due to high radiation exposure.
MRI has a number of advantages: non-invasiveness, absence of ionizing radiation, high image contrast. During the first week of the disease, it is possible to identify an inflammatory process in the intervertebral disc and surrounding tissues, protrusion of discs and fragments of end plates of vertebral bodies into the spinal canal, and assess its condition. The affected disc reduces the signal in the T1 mode (hypointense) and hyperintense in the T2 mode. MRI helps in the early differential diagnosis of inflammatory diseases of the spine with neoplasms and traumatic injuries.
Scanning with Tc99m medronate (pyrophosphate) or Ga67 citrate is a sensitive method that determines the focus of inflammation in the intervertebral disc space 3–7 days after the onset of the disease. Scintigraphy detects localization and allows the doctor to know the stage of the process. But the method does not have high specificity, since the radiopharmaceutical accumulates in the affected disc, in adjacent vertebrae, in tumors, and in the fracture zone. Scintigraphy is used in young children as screening when topical detection of the lesion is difficult.
Ultrasound and thermal imaging are not very informative and are only auxiliary in the diagnosis of discitis.
Do not confuse diskite with coxite
The course of intervertebral discitis in children is favorable; a biopsy, as a rule, is not indicated, but it is necessary in the case of a chronic or fulminant (instantaneous) process; if abscess formation, tuberculosis, fungal infection is suspected; failure of antibacterial treatment. Puncture of the intervertebral space - under fluoroscopic control - through the paraspinal muscles below the lateral process of the vertebra. When puncturing the lumbar spine, one must remember the localization of the inferior vena cava and aorta, located directly in front of the spine.
Discitis should be differentiated from vertebral osteomyelitis, coxitis, gonitis, tuberculous spondylitis, meningitis, Grisel's disease, and in the case of abdominal syndrome - with acute appendicitis. With discitis of the lumbar spine, lameness and complaints of pain in the hip and knee joints are often regarded as coxitis or driving. The main differences are that there is no inflammatory process, passive movements in the joints are preserved. Abdominal pain, fever, inflammatory changes in blood tests raise suspicion of acute appendicitis. In this case, observation and additional research methods (ultrasound, laparoscopy) will help make the correct diagnosis. With pain in the flanks and lower back, a urinary tract infection can be assumed, but a urine test puts everything in its place.
Torticollis in patients with Grisel's disease is caused by rotational displacement of the atlas with asymmetric contracture of the paravertebral muscles attached to it and the base of the skull. This is preceded by an inflammatory process in the pharynx and nasopharynx. In the upper cervical spine, the protruding spinous process of CII is palpated, and from the side of the pharynx, on the posterior wall, an elevation appears, corresponding to the displaced atlas. An x-ray (taken through an open mouth) shows a subluxation of the atlas - the vertebra moves anteriorly with simultaneous rotation around a vertical axis.
When there is pain in the head, neck, back, muscle spasm and meningeal signs, meningitis can be suspected, but the absence of focal symptoms and a negative result of a spinal puncture exclude such a diagnosis. In acute hematogenous osteomyelitis of the spine, the disease is severe and there are destructive changes in the vertebrae. Need a CT scan. X-ray examination of the chest and specific tests will help differentiate discitis from tuberculous spondylitis. One should remember about the multiplicity of vertebral lesions and predominant localization in the thoracic region, pronounced destruction of the vertebral bodies; that the tuberculosis process proceeds more slowly.
With Scheuermann-Mau disease, a narrowing of the intervertebral space is also noted, but attention should be paid to the kyphotic deformation of the back, the characteristic wedge-shaped shape of the vertebra, localization in the thoracic region and the absence of the inflammatory process characteristic of discitis. After an injury, there may also be a narrowing of the disc space. In this case, it is important to carefully collect anamnesis. Differential diagnosis is also carried out with rare diseases - spinal cord tumor, Guillain-Barre syndrome, transverse myelitis, poliomyelitis, muscular dystrophy.
Bed rest
Treatment of discitis in children is predominantly conservative. This includes bed rest, unloading of the spine, immobilization (head holder, corset). When prescribing antibiotics, one must take into account their low permeability in the tissue of the intervertebral disc; blood circulation in it decreases in older children. Antibiotics are selected empirically; the physician should be aware of the more frequent isolation of S. aureus from the affected disc space. An increase in the activity of phospholipase A2 (observed in intervertebral disc pathology) forces one to resort to non-steroidal anti-inflammatory drugs that reduce the activity of this enzyme. The treatment complex includes nonspecific anti-inflammatory drugs (ibuprofen), antihistamines, and detoxification therapy.
The disease subsides quite quickly. Within two to three days, the pain syndrome decreases, the child begins to move his head and torso more actively. For the first 2–3 weeks there should still be bed rest, then dosed walking is allowed; for thoracic and lumbar localization of discitis - with the help of crutches. We need therapeutic restorative gymnastics and physiotherapy (UHF, calcium electrophoresis). The immobilization period generally does not exceed 4 weeks. The duration of treatment (usually 3–4 weeks) is dictated by the duration of the pain syndrome and the data of the radiation study. In laboratory indicators, you need to focus on acute-phase proteins and ESR. By this time, blood tests are almost normal. Later than everyone else - ESR (after 2-3 months).
The duration of hospitalization is 3–4 weeks. Outpatient under control - motor regimen, physical activity, x-ray examination.
Surgical treatment of children with discitis can be considered for prevertebral abscesses, especially in the cervical spine (dangerous due to compression and development of asphyxia), disc lysis with pathological instability of the spine, and compression of the spinal cord. During the operation, osteoperiosteal decortication of the affected spinal segment is performed. The anterior longitudinal ligament with a thin layer of cortical plate is separated, the remains of the affected disc are removed, and the contact surfaces of the vertebral bodies are resected before bleeding from the spongiosa. Spondylodesis is performed using an autograft from the iliac crest. The results of treatment for discitis in most children are favorable. However, even in the absence of complaints, 75% of patients eventually develop radiographic changes in the spine. If treatment is started late, a narrowing of the intervertebral space occurs with usuration of the endplates and sclerosis of the subchondral layer of the adjacent vertebral bodies, and a blockade of the affected intervertebral space may develop. Asymmetry of the disc space can form scoliosis with structural changes in the adjacent vertebral bodies. Complete restoration of disc space height is observed in less than 10% of children, mostly of preschool age. Intervertebral discitis suffered in childhood can subsequently cause vertebralgia.
Case from practice Patient G., 5.5 years old. He was hospitalized in a children's surgical hospital with complaints of pain in the lower back and sacrum, weakness, and sleep disturbances. It all started three days ago - after a bruise in the lower back; the temperature rose to 38°C. On admission the condition was of moderate severity. T=37.4°C. Physical development corresponds to age. He walks reluctantly and limps. Scoliosis with curvature of the spine to the right. Lumbar lordosis is smoothed. Moderate swelling of soft tissues in the lower back on the right, increased venous pattern of the skin. Movements in the lower back are difficult, bending the body is impossible. Pain in the lower lumbar and upper sacral spine. There are no pathologies of internal organs or data on damage to the peripheral nervous system. Complete blood count: neutrophilia, ESR 16 mm/h; biochemical - increased levels of acute-phase proteins (CRP, ceruloplasmin, seromucoids). X-ray: lumbar lordosis is smoothed, no bone changes are detected. Ultrasound: structural changes in the soft tissues of the lumbosacral region and both m. iliopsoas was not detected. Rheovasography of the sacroiliac areas: arterial blood supply on the right is reduced by 27% against the background of persistent spasm of small-caliber arteries. Venous drainage with signs of transient obstruction. Clinical diagnosis: acute hematogenous osteomyelitis LV–SI. Antibacterial treatment, infusion therapy, and spinal unloading were prescribed.
After 3 weeks the condition improved. The pain has decreased significantly, and the range of motion in the lower back has increased. The phthisiatrician did not establish any pathology. Complete blood count: normal leukocyte count, ESR 36 mm/h, biochemical — moderately elevated levels of CRP, ceruloplasmin and seromucoids remain. X-ray: reduced height of the LV–SI intervertebral space. CT scan: lytic destruction of the upper contour of the SI and the lower contour of the body of the LV, rarefaction and destructive changes in the intervertebral disc. MRI: usuration of the caudal endplate of the body LV and the cranial endplate of the body SI. The height of the LV–SI disc has been reduced. Hyperintense signal of the affected disc in T2 mode. The surrounding soft tissues are unchanged. Rheovasography: arterial blood supply to the right sacroiliac region is increased by 22%, tissue perfusion is effective (signs of “directed” hyperemia). Conclusion: inflammatory process in the LV–SI disc space.
After 1.5 months of treatment (cefazolin, lincomycin, rifampicin, detoxification therapy, spinal unloading), the condition is satisfactory. There is no pain in the lumbosacral region. Complete blood count: normal leukocyte count, ESR 12 mm/h. X-ray of the lumbosacral spine: the lower contour of the LV body in the anterior section is poorly visible, the upper contour of S1 is unclear. The narrowing of LV–SI disk space persists. Rheovasography: arterial blood supply to the right lumbosacral region is unstable, slightly reduced. Vascular tone and venous outflow are normal. Minor interstitial swelling of soft tissues. Final diagnosis: discitis LV–SI. Discharged home.
The child was examined after 1 year, 3 and 5 years - no complaints. Develops normally. Mobility in the lumbar spine is preserved. X-ray of the lumbosacral spine: enlargement of the LV body, decreased height of the LV–SI disc space, sclerosis of the LV and SI endplates.
Intervertebral discitis in children is not such a rare disease as is commonly believed. Early diagnosis is difficult because patient complaints and clinical manifestations are nonspecific. Despite this, it is necessary to conduct a study of the spine. A correct diagnosis prevents unnecessary procedures and interventions (spinal puncture, laparotomy, arthrotomy, etc.). Intervertebral discitis should be assumed if the child’s general condition has worsened, the body temperature has increased, vague pain has appeared in the neck, back, abdomen or legs, and the cause has not been established. The alertness of doctors and the use of modern research methods (MRI, CT) will allow you to quickly make an accurate diagnosis and quite soon see the results of treatment for intervertebral discitis.
The material is intended for doctors: pediatricians, pediatric surgeons, phthisiatricians, etc.
Yuri Abaev , Professor of the Department of Pediatric Surgery of BSMU, Doctor of Medicine. Sciences Medical Bulletin , September 18, 2013
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What medicines to use when it hurts
The only safe painkillers for children are paracetamol and ibuprofen. Depending on the age and weight of the child, you can choose syrup, suppositories or tablets.
If these medications don't help your pain, only your doctor can decide what to do next.
Warming patches and ointments with anti-inflammatory and analgesic properties are intended for adults and older adolescents.
A child's thin skin allows medications contained in patches or ointments to be easily absorbed, and is too sensitive to the effects of the substances they contain.
Treatment
Conservative treatment
- includes the use of analgesics, temporary fixation of the spine in a special corset, performing complex exercises, physiotherapy and special massage. Adequate conservative treatment using recommendations for physical activity, as a rule, leads to complete regeneration of bone tissue. Rehabilitation after a compression fracture of the spine in children includes taking all necessary measures to create a strong muscular system, restoring strength and blood supply to the vertebrae.
There are several periods in the treatment of simple compression fractures of the spine.
- Inpatient period, lasting up to 30 days, with mandatory stay in the department, laying on a backboard with the leg lowered and functional traction.
- Outpatient - from the 31st to the 60th day, in turn, is divided into several stages, depending on tolerance to physical activity and the volume of dosed exercise therapy.
- The recovery period, from 61 days until the end of the first year, during which it is necessary to sleep on a hard surface, daily physical exercise, courses of massage, inductothermy, and magnetic therapy are required. The child is observed by an orthopedic doctor for 2 years after the injury.
The main task of the first stage of treatment is pain relief, immobilization and unloading of the spine, which is achieved by stretching the spine. To do this, the child is placed with his back on a hard surface, raising his head 30 cm, and then the load is secured with fabric straps and the armpits are secured. Drug treatment can reduce pain and remove negative emotional background, and also helps restore blood flow in the damaged area. The patient's bed should be hard and physical activity should be avoided. The duration of the first period of treatment for a compression fracture of the spine in children is approximately one month, but may be longer. All this time there must be bed rest, and only the doctor can decide when to sit and stand.
At the next stage of treatment, the choice of fracture treatment tactics depends on the severity of the injury. For complex injuries in the lumbar or thoracic region, when three or more vertebrae are deformed, it is recommended to wear a corset. In particularly difficult cases, surgery may be required.
In order to fully restore the function of the spine, long-term rehabilitation is required, including physiotherapeutic procedures, massage and exercise therapy.
Exercise helps strengthen the spine and restore flexibility and mobility. Depending on the condition, physiotherapy or massage is prescribed to help restore blood circulation and muscle tone. The rehabilitation period may take more than two months, after which the child must be examined several times by a traumatologist within two years after the injury.
Surgical methods of treatment. Methods such as
Kyphoplasty and vertebroplasty are indicated for complex fractures and allow better fixation of the vertebra. Open surgery is used only for severe vertebral fractures.