Physeal Stress Injuries of the Spine

Back pain is a common pediatric problem. While most cases will resolve, at times patients can have an underlying spinal pathology. Notably, disruption of the bony pars interarticularis between the posterior elements and the vertebral body can occur because of dysplasia, trauma, or repeated stress. If this progresses to slippage or spondylolisthesis, patients may require surgical intervention. Other problems may also exist including stress fractures of the vertebral endplate, fractures of the anterior or posterior edges of the endplate known as limbus fractures, or apophyseal fractures of the spinous processes. Most of the pathologies can be managed nonoperatively; however, diagnosis through physical exam and appropriate workup with imaging is imperative to identifying the appropriate diagnosis.