Skip to main content

Advertisement

SpringerLink
Log in

Streamlining the Evaluation of Low Back Pain in Children

  • Original Article
  • Published:
Clinical Orthopaedics and Related Research

Abstract

The workup of low back pain in children often results in overimaging so as not to miss organic back pain. The primary goal of this study was to identify which combination of imaging modalities provides the most sensitive and specific screening protocol for children with low back pain. Medical records from 100 consecutive patients between 2 and 18 years of age presenting with low back pain, without night pain or constitutional symptoms, were evaluated. A hyperextension test combined with a radiograph showed a negative predictive value of 0.81 and sensitivity of 0.90. The addition of a bone scan was highly effective in achieving good negative predictive value and sensitivity. Bone scans had perfect negative predictive value and sensitivity when symptom duration was less than 6 weeks. We identified a set of factors that is highly predictive for distinguishing organic back pain from mechanical back pain. Painless hyperextension combined with negative anteroposterior, lateral, and oblique lumbar radiographs and magnetic resonance images predicts mechanical back pain. For patients with nonneurologic back pain of less than 6 weeks duration, bone scan is the most useful screening test because it is accurate, accessible, inexpensive, and unlikely to require sedation.

Level of Evidence: Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2A–B
Fig. 3A–B

Similar content being viewed by others

References

  1. Balague F, Dutoit G, Waldburger M. Low back pain in schoolchildren: an epidemiological study. Scand J Rehabil Med. 1988;20:175–179.

    PubMed  CAS  Google Scholar 

  2. Bellah RD, Summerville DA, Treves ST, Micheli LJ. Low-back pain in adolescent athletes: detection of stress injury to the pars interarticularis with SPECT. Radiology. 1991;180:509–512.

    PubMed  CAS  Google Scholar 

  3. Bodner RJ, Heyman S, Drummond DS, Gregg JR. The use of single photon emission computed tomography (SPECT) in the diagnosis of low-back pain in young patients. Spine. 1988;13:1155–1160.

    Article  PubMed  CAS  Google Scholar 

  4. Bono CM. Low-back pain in athletes. J Bone Joint Surg Am. 2004;86:382–396.

    PubMed  Google Scholar 

  5. Campbell RS, Grainger AJ, Hide IG, Papastefanou S, Greenough CG. Juvenile spondylolysis: a comparative analysis of CT, SPECT and MRI. Skeletal Radiol. 2005;34:63–73.

    Article  PubMed  CAS  Google Scholar 

  6. Cohen E, Stuecker RD. Magnetic resonance imaging in diagnosis and follow-up of impending spondylolysis in children and adolescents: early treatment may prevent pars defects. J Pediatr Orthop B. 2005;14:63–67.

    PubMed  Google Scholar 

  7. Colliver V. Curbing costs of medical scans: insurers seek to rein in fast-growing use of pricey high-tech MRIs and CTs. San Francisco Chronicle. 2005:E1.

  8. Costs of inpatient drugs rise rapidly than other hospital services. Available at: www.solucient.com/news_press/news20040817.shtml. Accessed August 20, 2004.

  9. Duggleby T, Kumar S. Epidemiology of juvenile low back pain: a review. Disabil Rehabil. 1997;19:505–512.

    Article  PubMed  CAS  Google Scholar 

  10. Dutton JA, Hughes SP, Peters AM. SPECT in the management of patients with back pain and spondylolysis. Clin Nucl Med. 2000;25:93–96.

    Article  PubMed  CAS  Google Scholar 

  11. Feldman DS, Hedden DM, Wright JG. The use of bone scan to investigate back pain in children and adolescents. J Pediatr Orthop. 2000;20:790–795.

    PubMed  CAS  Google Scholar 

  12. Ginsburg GM, Bassett GS. Back pain in children and adolescents: evaluation and differential diagnosis. J Am Acad Orthop Surg. 1997;5:67–78.

    PubMed  Google Scholar 

  13. Harvey CJ, Richenberg JL, Saifuddin A, Wolman RL. The radiological investigation of lumbar spondylolysis. Clin Radiol. 1998;53:723–728.

    Article  PubMed  CAS  Google Scholar 

  14. Hensinger RN. Back pain in children. In: Bradford DS, Hensinger RN, eds. The Pediatric Spine. New York, NY: Thieme Inc; 1985:41–60.

    Google Scholar 

  15. King HA. Back pain in children. Pediatr Clin North Am. 1984;31:1083–1095.

    PubMed  CAS  Google Scholar 

  16. King HA. Back pain in children. In: Weinstein SL, ed. The Pediatric Spine: Principles, Practice. Philadelphia, PA: Lippincott Williams & Wilkins; 2001:123–132.

    Google Scholar 

  17. Malviya S, Voepel-Lewis T, Prochaska G, Tait AR. Prolonged recovery and delayed side effects of sedation for diagnostic imaging studies in children. Pediatrics. 2000;105:E42.

    Article  PubMed  CAS  Google Scholar 

  18. Malviya S, Voepel-Lewis T, Tait AR. Adverse events and risk factors associated with the sedation of children by nonanesthesiologists. Anesth Analg. 1997;85:1207–1213.

    Article  PubMed  CAS  Google Scholar 

  19. Mandell GA. Nuclear medicine in pediatric musculoskeletal imaging. Semin Musculoskelet Radiol. 1999;3:289–316.

    Article  PubMed  Google Scholar 

  20. Olsen TL, Anderson RL, Dearwater SR, Kriska AM, Cauley JA, Aaron DJ, LaPorte RE. The epidemiology of low back pain in an adolescent population. Am J Public Health. 1992;82:606–608.

    PubMed  CAS  Google Scholar 

  21. Papanicolaou N, Wilkinson RH, Emans JB, Treves S, Micheli LJ. Bone scintigraphy and radiography in young athletes with low back pain. AJR Am J Roentgenol. 1985;145:1039–1044.

    PubMed  CAS  Google Scholar 

  22. Ralston S, Weir M. Suspecting lumbar spondylolysis in adolescent low back pain. Clin Pediatr (Phila). 1998;37:287–293.

    CAS  Google Scholar 

  23. Roberts FF, Kishore PR, Cunningham ME. Routine oblique radiography of the pediatric lumbar spine: is it necessary? AJR Am J Roentgenol. 1978;131:297–298.

    PubMed  CAS  Google Scholar 

  24. Ryan PJ, Evans PA, Gibson T, Fogelman I. Chronic low back pain: comparison of bone SPECT with radiography and CT. Radiology. 1992;182:849–854.

    PubMed  CAS  Google Scholar 

  25. Saifuddin A, Burnett SJ. The value of lumbar spine MRI in the assessment of the pars interarticularis. Clin Radiol. 1997;52:666–671.

    Article  PubMed  CAS  Google Scholar 

  26. Salminen JJ, Pentti J, Terho P. Low back pain and disability in 14-year-old schoolchildren. Acta Paediatr. 1992;81:1035–1039.

    Article  PubMed  CAS  Google Scholar 

  27. Selbst SM, Lavelle JM, Soyupak SK, Markowitz RI. Back pain in children who present to the emergency department. Clin Pediatr (Phila). 1999;38:401–406.

    CAS  Google Scholar 

  28. Sward L, Hellstrom M, Jacobsson B, Nyman R, Peterson L. Disc degeneration and associated abnormalities of the spine in elite gymnasts: a magnetic resonance imaging study. Spine. 1991;16:437–443.

    Article  PubMed  CAS  Google Scholar 

  29. The Committee on Ways and Means. Johnson announces hearing on managing the use of imaging services. Available at: http://waysandmeans.house.gov/hearings.asp?formmode=printfriendly&id=2538. Accessed March 10, 2005.

  30. Turner PG, Green JH, Galasko CS. Back pain in childhood. Spine. 1989;14:812–814.

    Article  PubMed  CAS  Google Scholar 

  31. Udeshi UL, Reeves D. Routine thin slice MRI effectively demonstrates the lumbar pars interarticularis. Clin Radiol. 1999;54:615–619.

    Article  PubMed  CAS  Google Scholar 

  32. Yamane T, Yoshida T, Mimatsu K. Early diagnosis of lumbar spondylolysis by MRI. J Bone Joint Surg Br. 1993;75:764–768.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, The University of Pennsylvania, 2 Silverstein, 3400 Spruce Street, Philadelphia, PA, 19104, USA

    Joshua D. Auerbach MD, Jaimo Ahn MD, PhD, Miltiadis H. Zgonis MD, Sudheer C. Reddy MD, Malcolm L. Ecker MD & John M. Flynn MD

  2. Division of Orthopaedic Surgery, The Children’s Hospital of Philadelphia, 2nd Floor, Richard D. Wood Building, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA

    Joshua D. Auerbach MD, Jaimo Ahn MD, PhD, Miltiadis H. Zgonis MD, Sudheer C. Reddy MD, Malcolm L. Ecker MD & John M. Flynn MD

Authors
  1. Joshua D. Auerbach MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jaimo Ahn MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Miltiadis H. Zgonis MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sudheer C. Reddy MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Malcolm L. Ecker MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. John M. Flynn MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John M. Flynn MD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent was obtained.

About this article

Cite this article

Auerbach, J.D., Ahn, J., Zgonis, M.H. et al. Streamlining the Evaluation of Low Back Pain in Children. Clin Orthop Relat Res 466, 1971–1977 (2008). https://doi.org/10.1007/s11999-008-0296-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-008-0296-2

Keywords

Search

Navigation