Pediatric neck pain of a 10-year-old child with cervical spinal tumor evaluated and managed in direct access physical therapy: a case report

Abstract

Introduction: Differential diagnosis of pediatric neck pain requires age-appropriate communication and assessment tools. Recognizing these age-related nuances is critical, emphasizing the role of physical therapists in assessing and managing pediatric patients while ruling out severe pathologies.

Case description: A 10-year-old male presented to physical therapy with a five-week history of increasing neck pain. A thorough history and segmental cervical examination considering the patient's age and development, led to patient referral to the emergency department. This case underscores the significance of comprehensive evaluation in pediatric neck pain management.

Outcomes: The patient was diagnosed with Langerhans Cell Histiocytosis (LCH). LCH primarily affects children and is treated with chemotherapy. Chemotherapy reduced the tumor, revealing C2 vertebral body damage. The patient underwent C1-C3 fusion surgery, a standard procedure for atlanto-occipital region stabilization in children. The patient was advised to restrict motion for 6 months while monitoring for tumor growth.

Discussion-conclusion: Pediatric neck cancer presents diagnostic challenges due to varied symptoms, but research highlights specific indicators to assist with differential diagnosis. This case emphasizes the need to recognize the complexities of pediatric neck pain and perform a thorough age-appropriate evaluation.

Keywords: Cancer; Langerhans Cell Histiocytosis; case report; red flags; spinal fusion.

Figure 1.

Multiplanar, multisequence MRI revealed reduced diffusion, and enhancement involving the C2 vertebrae (odontoid, vertebral body, right pedicle, right lamina, and spinous process) with soft tissue extension into the right prevertebral space, right.

Figure 2.

CT image revealing collapse of C2 vertebral body (white arrow) with increased narrowing of right atlantoaxial joint and new pathologic fracture in a posterior neural arch.

Figure 3.

Status post posterior fusion of C1-C3.

Figure 4.

Patient care timeline- WNL = within normal limits; ROM = range of motion.