A Case of a Boy with Neck Pain at Night Associated with Acute Torticollis and Kyphoscoliosis

Complaints of neck and back pain in children are commonly seen in the office and hospital setting. Typically, pain is self-limiting and does not routinely require additional workup with advanced imaging or intervention. A proper history and physical examination can identify “red flag” signs and symptoms such as new or progressive deformity, radicular pain, night pain, and neurological deficits. If positive, advanced imaging is indicated. In a child with neck pain, acquired torticollis may be a primary presenting symptom. Acquired torticollis in a child is different than infantile muscular torticollis. Causes of acquired torticollis and neck pain include minor trauma or infection, but can also represent structural spinal abnormalities or soft tissue masses and tumors. Symptoms may respond well to conservative management with rest, stretching, and mild analgesics. Computed tomography (CT) imaging is useful in patients suspected of having structural abnormalities. Magnetic resonance imaging (MRI) is indicated for patients experiencing red-flag symptoms. Referral to a pediatric orthopedic spine surgeon or neurosurgeon is recommended if the physical exam or imaging findings are concerning.