🦴 Section 728.4 · Low Back Injuries

Nelson Textbook of Pediatrics 22nd Edition | Spondylolysis: pars interarticularis defect (stress fracture), L5 most common. Spondylolisthesis: forward slippage (Meyerding I-V). Pain worse with extension (single-leg hyperextension test). Imaging: oblique radiographs (Scotty dog with collar), MRI (STIR) or SPECT for early detection. Treatment: activity modification, physical therapy (core strengthening, hamstring stretching), TLSO brace. Surgery (posterolateral fusion) for high-grade spondylolisthesis (III-V), progressive slip, or neurologic deficit. Lumbar disc herniation: rare in children, pain with flexion, positive straight leg raise. Conservative first; surgery for cauda equina or progressive deficit.

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📋 30 Clinical Scenarios — Low Back Injuries

📇 High‑Yield Review Cards

🩺 Clinical Recognition: Low Back Injuries

Select a presentation to review diagnostic clues and management per Nelson 728.4.

📋 Stepwise Management of Low Back Injuries

🔑 Key Principles — Nelson Section 728.4
• Spondylolysis: Pars defect (stress fracture). Pain worse with extension, single-leg hyperextension test. Imaging: oblique radiographs (Scotty dog defect). MRI (STIR) or SPECT for early detection.
• Spondylolisthesis: Forward slippage (Meyerding I-V). L5 on S1 most common. Hamstring tightness (popliteal angle). Low-grade (I-II) → conservative. High-grade (III-V) or progressive → surgery (posterolateral fusion).
• Lumbar disc herniation: Rare in children. Pain with flexion, positive straight leg raise. Conservative first (6-8 weeks). Surgery for cauda equina, progressive deficit, or failure of conservative care.
• Sacroiliitis: Pain over sacroiliac joints, positive Patrick (FABER) test. Consider ankylosing spondylitis (morning stiffness, uveitis, HLA-B27).

    ⚡ Reflex Prompts — Clinical Decisions

    📖 Summary: Low Back Injuries (Nelson 728.4)