title: Low back pain in a child associated with acute onset cauda equina syndrome:  a rare presentation of an aggressive vertebral hemangioma:  a case report.
abstract: BACKGROUND
  Back pain prevalence in the pediatric age group is less compared with adults. There is a wide range of possible etiologies, and tumors such as primary spinal hemangiomas are uncommon. Most are incidental findings and asymptomatic; however, painful lesions can be presented in up to 0.9% to 1.2% of cases. These lesions can produce neurologic involvement either spinal cord compression or cauda equina syndrome as in our case. The aim of this study is to describe a case of low back pain in a child due to a vertebral hemangioma complicated with acute cauda equina syndrome, and performed a literature review that will help us to recognize this aggressive variance making an early treatment feasible.
  
  
  METHODS
  A 13-year-old female, follow-up in an outer health care center due to a L1 vertebral hemangioma, characterized by 3 years of low back pain without neurologic symptoms presented to our emergency department with an acute cauda equina syndrome.
  
  
  RESULTS
  An outside magnetic resonance imaging showed complete obliteration of the spinal canal at the level of the conus medullaris related to retropulsion of bone at L1. She underwent 2-stage surgical treatment: complete posterior L1 laminectomy and partial T12-L2 laminectomies, with partial L1 vertebrectomy and posterior fusion with instrumention from T11 to L3. Three weeks later, embolization before anterior fusion with inner body cage was performed. Forty months after surgery, she is doing well with no neurologic deficits.
  
  
  CONCLUSIONS
  Even though hemangiomas are not a common cause of back pain, they should be taken into account. It is important to recognize the aggressive variance so an early treatment could be performed. There is no enough clinical data to establish guidelines of management in children, therefore, the treatment should be individualized.
authors.affiliation: The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. pretellj@email.chop.edu
authors.forename: Juan
authors.initials: J
authors.lastname: Pretell-Mazzini
authors.forename: Kudakwashe R
authors.initials: KR
authors.lastname: Chikwava
authors.forename: John Paul
authors.initials: JP
authors.lastname: Dormans
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006391:Hemangioma / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007796:Laminectomy / Q000379:methods; D017116:Low Back Pain / Q000209:etiology*; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D011128:Polyradiculopathy / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D013123:Spinal Fusion / Q000379:methods; D013125:Spinal Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery