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
• red flags
• spinal fusion
• case report

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This project was not supported by grant funding

Notes on contributors

Virginia K Henderson

Virginia K. Henderson PT, DPT is a pediatric physical therapist in the department of orthopedics and sports medicine at Texas Children’s Hospital. She completed her Master’s of Physical Therapy at The University of Texas Health Science Center in San Antonio, and her transitional Doctorate of Physical Therapy at Texas Women’s University. She completed her manual therapy fellowship with The Manual Therapy Institute. Dr. Henderson is currently an ScD student at Texas Tech University Health Sciences Center and is studying the application of joint mobilization in the pediatric population.

Jean-Michel Brismée

Jean-Michel Brismée PT, ScD is professor in the Doctor of Science and Doctor of Philosophy programs in Rehabilitation Science at Texas Tech University Health Sciences Center in Lubbock, Texas, and teaches orthopedic manual therapy related continuing education courses with the International Academy of Orthopedic Medicine (IAOM-US).