599: The prevalence of spinal pathologies in children and adolescents seeking care for back pain

Topic: Education, Societal Impact, and Others
Subtopic: ICD-11 & ICF

Background and Aims: Back pain is a leading cause of disability among children and adolescents worldwide. While it is often assumed that only a small proportion of those seeking care for back pain have serious underlying conditions, this assumption is primarily based on adult data, leaving a critical knowledge gap regarding the reality in younger populations. No studies have reviewed the evidence on prevalence of spinal and non-spinal pathologies in children and adolescents. The aim of this systematic review was to estimate the prevalence of spinal and non-spinal pathologies in children and adolescents seeking care for back pain.

Methods: We searched the CINAHL, MEDLINE, and EMBASE databases for observational studies reporting the prevalence of spinal or non-spinal pathologies in children and adolescents seeking care for back pain. Eligible participants were ≤24 years, presented to healthcare settings with acute, subacute, or chronic back pain and received a clinical diagnosis. Serious spinal pathologies included trauma, infection, tumour, or cauda equina syndrome, while non-spinal causes included conditions not originating in the spine, such as renal or systemic disorders. Studies were required to report extractable prevalence data. Two reviewers independently screened records, extracted data, and assessed risk of bias.

Results: A total of 10,137 records were identified, of which 42 studies met the inclusion criteria. Seventeen studies reported the prevalence of serious spinal pathology in children and adolescents with low back pain, with a pooled prevalence of 0.5 (95% confidence interval: 0.3 to 0.6) and substantial heterogeneity (I²=97.8%). Non-serious spinal pathology, also reported in 17 studies, ranged from 0.4% to 98.6%, with spondylolysis, Scheuermann’s disease, and scoliosis most commonly identified. Tumours, infections, and fractures were rare. Non-spinal causes were reported in two studies and included hydronephrosis and kidney disease, highlighting variability across populations, settings, and diagnostic approaches.

Conclusions: The prevalence of serious spinal pathology in children and adolescents presenting with low back pain was low but highly variable across studies. Substantial heterogeneity suggests differences in populations, diagnostic approaches, and clinical settings. Structured diagnostic strategies and clear care pathways may support timely identification of serious and non-spinal conditions while avoiding unnecessary investigations.

References: 1. Henschke N, Kamper SJ, Maher CG. The epidemiology and economic consequences of pain. Mayo Clin Proc. 2015 Jan;90(1):139-47.
2. Balagué F, Mannion AF, Pellisé F, et al. Non-specific low back pain. Lancet. 2012 Feb 4;379(9814):482-91
3. Calvo-Munoz I, Gomez-Conesa A, Sanchez-Meca J. Prevalence of low back pain in children and adolescents: a meta-analysis. BMC Pediatrics 2013; 13: 14.
4 Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, Hoy D, Karppinen J, Pransky G, Sieper J, Smeets RJ, Underwood M; Lancet Low Back Pain Series Working Group. What low back pain is and why we need to pay attention. Lancet. 2018 Jun 9;391(10137):2356-2367.
5. Henschke N, Harrison C, McKay D, Broderick C, Latimer J, Britt H, Maher CG. Musculoskeletal conditions in children and adolescents managed in Australian primary care. BMC Musculoskelet Disord. 2014 May 20;15:164.

Presenting Author: Yasmin Brasileiro de Souza
Submitting Author: Yasmin Souza

Senior Author: Gisela Cristiane Miyamoto

IASP 2026 Global Year theme of Neuropathic Pain: No

• Gisela Cristiane Miyamoto: Post doctoral - Ribeirão Preto Medical School, University of São Paulo, Brazil.
• Crystian Bitencourt Oliveira: Post doctoral - Institute of Musculoskeletal Health, School of Public Health, University of Sydney, Australia.
• Payton Soussa: PhD Student - Faculty of Medicine and Health, University of Sydney, Australia.
• Laura Montgomery: PhD - Faculty of Medicine and Health, University of Sydney, Australia.
• Verônica Souza Santos: Post doctoral - Ribeirão Preto Medical School, University of São Paulo, Brazil; School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
• Christopher Maher: Research fellow - Institute of Musculoskeletal Health, School of Public Health, University of Sydney, Australia.
• Steve J. Kamper: Research fellow - Nepean Blue Mountains Local Health District, Australia; Faculty of Medicine and Health, University of Sydney, Australia.
• Tiê Parma Yamato: Research Fellow - Nepean Blue Mountains Local Health District, Australia; Faculty of Medicine and Health, University of Sydney, Australia.