MURAT BEZER, Bülent EROL, Barış KOCAOĞLU, NURİ AYDIN, Osman GÜVEN

Çocuk ve adölesanlarda görülen sırt ve bel ağrıları

Amaç: Çocuklarda sırt ve bel ağrısının tanı ve tedavisi konusunda deneyimlerimizi sunmak. Çalışma planı: Sırt ve bel ağrısı nedeniyle tedavi ettiğimiz ve düzenli takipleri yapılan 29 çocuk hasta (15 kız, 14 erkek; ort. yaş 12; dağılım 9-17) geriye dönük olarak incelendi. Biyolojiye yönelik çalışmalarda klinik inceleme, radyolojik inceleme ve laboratuvar testlerine başvuruldu. Bu araştırmalar sonucunda belirli bir nedenin saptanamadığı olgularda semptomatik tedavi uygulandı. Ortalama izlem süresi 42 ay (dağılım 12-96 ay) idi. Sonuçlar: Yirmi altı hastada (%89) sırt-bel ağrısının nedeni belirlendi. Tanılar, spondilolizis/spondilolistezis (n=8), Scheuermann hastalığı (n=6), neoplazi (n=5), diskit/vertebral osteomiyelit (n=4) ve lumbar disk hernisi (n=3) şeklindeydi. İzole spondilolizisli yedi hastaya konservatif tedavi; spondilolistezisin eşlik ettiği bir hastaya in situ füzyon uygulandı. Scheuermann hastalığı olan bir olguya spinal füzyon yapıldı; diğer olgular konservatif olarak izlendi. Neoplaziler, konservatif tedavi uygulanan bir hasta dışında, biyopsi, küretaj ve greftleme yöntemleriyle tedavi edildi. Diskitli iki hastaya antibiyotik tedavisi; vertebra osteomiyelitli iki olguya (Pott apsesi) tıbbi tedaviye ek olarak, drenaj ve strut greftle stabilizasyon uygulandı. Disk hernili bir hastaya disk fragmanlarının eksizyonu ve sınırlı laminektomi, iki hastaya konservatif tedavi uygulandı. Hastaların tümünde tam klinik iyileşme sağlandı. Çıkarımlar: Çocuklarda geçmeyen sırt-bel ağrıları ciddiye alınmalıdır. Bu ağrılar iyi bir öykü ve fizik muayene, radyolojik inceleme ve laboratuvar testleriyle değerlendirilebilmekte ve uygun tedaviyle iyileşme sağlanmaktadır.

Anahtar Kelimeler:

Bel ağrısı, Lumbosakral bölge, Ergen, Çocuk, Lumbar omurga

Low back pain among children and adolescents

Objectives: We presented our experience with the diagnosis and treatment of low back pain in children. Methods: We retrospectively reviewed 29 children (15 girls, 14 boys; mean age 12 years; range 9 to 17 years) who were treated for low back pain and had appropriate follow-ups. Etiologic causes were sought by clinical evaluation, radiologic studies, and laboratory tests. Patients with unknown etiology underwent symptomatic treatment. The mean follow-up period was 42 months (range 12 to 96 months). Results: Etiology was determined in 26 patients (89%), which included spondylolysis/spondylolisthesis (n=8), Scheuermann's disease (n=6), neoplasia (n=5), discitis/vertebral osteomyelitis (n=4), and lumbar disc herniation (n=3). Spondylolysis was managed conservatively, except for one patient who had in situ spinal fusion for associated spondylolisthesis. Five patients with Scheuermann's disease were treated conservatively, while one patient required spinal fusion. Surgical treatment with biopsy, curettage, and bone grafting was performed for all neoplasias, but one which was followed-up conservatively. Two patients with discitis were managed with antibiotic treatment and two patients with vertebral osteomyelitis (Pott's abscess) underwent both medical treatment and surgical drainage and stabilization with strut graft. Lumbar disc herniation was treated conservatively in two patients, while one had surgical treatment with excision of disc fragments and limited laminectomy. Finally, all the patients became asymptomatic on final examinations. Conclusion: Serious consideration should be given to persistent low back pain in children. Clinical, radiologic, and laboratory findings can be elaborated into etiologic diagnoses and complete relief can be achieved with appropriate treatment.

Keywords:

Low Back Pain, Lumbosacral Region, Adolescent, Child, Lumbar Vertebrae,

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