Differential Diagnosis of Painful Scoliosis in a Child

Scoliosis in adults often presents with pain. Idiopathic scoliosis in children, on the other hand, is often painless. When children present with painful scoliosis, especially if there is a left-sided curve, the following conditions should be considered:

• Vertebral tumours: osteoid osteoma, osteoblastoma, aneurysmal bone cyst, Langerhans cell histiocytosis
• Intraspinal tumours: neurofibroma; astrocytoma
• Infection: tuberculosis, discitis, osteomyelitis
• Scheuermann kyphosis
• Disc disease: disc herniation, Schmorl nodes
• Spondylolysis: spondylolisthesis
• Degenerative: facet joint arthritis, spinal stenosis, nerve root compression

References

• Taylor LJ, Painful scoliosis: a need for further investigation. Br Med J (Clin Res Ed). 1986 January 11; 292(6513): 120–122.
• Davies A, Saifuddin A. Imaging of painful scoliosis. Skeletal Radiol. 2009 Mar;38(3):207-23.