Question: Back Pain
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You are seeing a 3 year old child with 3 weeks of gradually progressing low back pain, now impacting her ability or willingness to walk. There has been no trauma and no fever noted at home, although temperature is 37.8 in the ED. On exam she has loss of lumbar lordosis and tenderness to palpation of the lumbar spine. She has full passive range of motion without pain of the hips. She was seen by her PCP 3 days ago and CBC was normal, blood cultures negative to date. Today, CBC is still normal and ESR is 47. Plain radiograph shows narrowing of the L3/4 disc space. MRI is not available in your ED.