Trauma and overuse
In cases of a traumatic fracture, dislocation, or ligamentous tear, a
history of a traumatic injury is not always apparent when the patient is
unconscious, demented, psychotic, under the influence of alcohol or
drugs, or a nonverbal child.3 On the contrary, a
history of injury does not necessarily mean that the pain has a
traumatic etiology, and it may be a ”red herring” that distracts from
the real cause. Strains and sprains of the spine are defined as
low-energy injury, overuse, or stretching of muscles or tendons and
ligaments.19 Whiplash injury is well described and can
lead to neck and back pain.20 A “clay shoveler’s
fracture” is an avulsion injury of the spinous processes of the
cervical-thoracic junction that can appear after injury or
overuse.21 SCIWORA (spinal cord injury without
radiographic abnormality) is a syndrome of traumatic injury/myelopathy
without radiological findings that was described in the
1970s’,22 was revealed as being a contusion of the
spinal cord by magnetic resonance imaging (MRI) scanning. Central cord
syndrome is defined by muscle weakness that is greater in the upper
extremities, as well as by urinary retention and various sensory
abnormalities.23 It is caused by hyperextension of the
neck that compresses the spinal cord, and can appear without
predeceasing spondylosis and narrowing of the spinal
canal.23 Pathological fractures due to osteoporosis,
infection, or a tumor can appear without injury or after only a minor
trauma.6 Stress fractures of the pars-interarticularis
(spondylolysis) are typical to adolescents that are physically active,
they appear more often in volleyball players and weightlifters, and the
pain is typically ”mechanical”24. Stress fractures of
the sacrum appear in osteoporotic patients and may be responsible for
low back pain.25 Apophysitis of the vertebrae
(Scheuermann’s disease/osteochondrosis) will appear in the thoracic
spine (75%) or in the lumbar spine in adolescents without apparent
history of overuse. Only 20-60% will have pain, and the rest will
develop a painless kyphotic deformity.24 Neurological
abnormalities are rare. Brown-Sequard syndrome is caused by injury to a
hemicord that can be traumatic or due to a tumor: ipsilateral paralysis
with loss of proprioception will typically be observed, with
contralateral loss of pain and temperature
sensation.26