7 Year Old Male with Acute on Chronic Back Pain - Abstract
A 7-year-old previously healthy male presented with sudden worsening of a chronic lower back pain that had been present intermittently for 7 months requiring ibuprofen. His review of systems was essentially negative. Family history was negative for malignancies. Physical examination was only positive for a limping gait with tenderness in the right lateral lumbar region. CT of the lumbar spine, CBC, ESR, and CRP were normal. A lumbosacral MRI with and without contrast demonstrated a cystic structure, at the level of L3. After surgical excision, histology revealed a squamous epithelium lined cyst consistent with an epidermoid cyst. Low back pain is an uncommon but often serious presentation in children with an extensive list of differential diagnoses including musculoskeletal, neurologic, rheumatologic, oncologic, renal and infectious etiologies. Intraspinalepidermoid cysts are rare thin-walled inclusions lined by stratified squamous epithelium. Low back pain is the most common presentation of intraspinalepidermoid
cysts. MRI is the imaging modality of choice and can distinguish intraspinalepidermoid cysts from other pediatric intraduralextramedullary spinal cord tumors. Spinal surgery is the mainstay of treatment and complete resection is usually curative.