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Six-year-old boy with a slow-onset persistent back pain
  1. Giulia Caddeo1,
  2. Paola Paganin2,
  3. Giulia Gortani3,
  4. Marco Carbone3,
  5. Massimo Gregori3,
  6. Egidio Barbi3
  1. 1 University of Trieste, Trieste, Friuli Venezia Giulia, Italy
  2. 2 Dipartimento di Scienze Mediche e Chirurgiche e della Salute, Universita degli Studi di Trieste, Trieste, Italy
  3. 3 Institute for Maternal and Child Health—IRCCS ‘Burlo Garofolo’, University of Trieste, Trieste, Italy
  1. Correspondence to Dr Paola Paganin, Universita degli Studi di Trieste Dipartimento di Scienze Mediche e Chirurgiche e della Salute, Trieste 34127, Italy; paganin1988{at}


A 6-year-old boy was evaluated for a 6-week history of low back pain. Initially, the pain was exacerbated by movements, eventually showing a milder and fluctuating trend. History was unremarkable for previous traumatic events, fever or nocturnal pain. Physical examination revealed localised pain at palpation of the spinous processes at the lumbosacral level. Blood tests showed a normal blood count, negative C reactive protein (CRP) and erythrocyte sedimentation rate, normal lactic acid dehydrogenase (LDH) and creatine phosphokinase.

A posterior–anterior radiograph of the lumbar spine resulted normal. An MRI scan revealed a lumbosacral transitional vertebra with bone oedema of the posterior arch until the spinous process.

For better bone definition, a CT scan was performed ( figure 1 ).

Figure 1

CT scan of the transitional lumbosacral (L5) vertebra.


  1. Which causes of persistent low back pain should be ruled out in children under 10 years of age?

    1. Osteochondrosis

    2. Neoplasm

    3. Functional pain

    4. Infections

  2. What is the diagnosis in this patient?

  3. How is the diagnosis performed?

  4. How is this condition managed?

Questions Answers can be found on page 2.

  • paediatric practice
  • orthopaedics
  • medical education
  • spondylosysis
  • pain

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  • Contributors All the authors contributed equally to the design and to the writing of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.