Myelography and Postmyelography CT Spine Because of the invasiveness of the procedure, myelography and postmyelography CT of the total spine are considered in the setting of an abnormal neurologic examination only if MRI is contraindicated or will have significantly limited diagnostic yield because of spinal hardware. Variant 5: Child. Chronic back pain associated with overuse. Mechanical back pain. Radiographs The most common etiology for overuse-related chronic back pain in children is spondylolysis. Radiography of the symptomatic region of the spine is a useful screening tool for spondylolysis, with a sensitivity of 77.6% for anterior-posterior and lateral radiographs [6]. The combination of negative radiographs and a negative clinical examination was reported to have an 0.81 negative predictive value [21]. Additional views did not significantly increase sensitivity [6,9]. Other reports have suggested a lower sensitivity for diagnosing spondylolysis using radiographs as compared to MRI [24]. Other etiologies for chronic back pain, such as apophyseal ring fractures and Scheuermann disease, may be suggested with radiographs alone [31]. MRI Spine MRI can show edema in the region of the pars interarticularis or adjacent pedicle in spondylolysis with negative radiographs and CT. MRI is especially useful in detection of active spondylolysis and has been positively associated with clinical symptomatology [23,24]. Resolution of signal abnormalities suggests a response to therapy and potential prevention of progression to fracture [22,37]. It remains uncertain whether MRI or bone scan with SPECT is preferred in the evaluation of suspected spondylolysis [38]. Abnormalities on MRI such as apophyseal injuries, spondylolysis, and disc disease have been shown to be associated with back pain in the pediatric athlete [39].
Back Pain Child PCAs. Myelography and Postmyelography CT Spine Because of the invasiveness of the procedure, myelography and postmyelography CT of the total spine are considered in the setting of an abnormal neurologic examination only if MRI is contraindicated or will have significantly limited diagnostic yield because of spinal hardware. Variant 5: Child. Chronic back pain associated with overuse. Mechanical back pain. Radiographs The most common etiology for overuse-related chronic back pain in children is spondylolysis. Radiography of the symptomatic region of the spine is a useful screening tool for spondylolysis, with a sensitivity of 77.6% for anterior-posterior and lateral radiographs [6]. The combination of negative radiographs and a negative clinical examination was reported to have an 0.81 negative predictive value [21]. Additional views did not significantly increase sensitivity [6,9]. Other reports have suggested a lower sensitivity for diagnosing spondylolysis using radiographs as compared to MRI [24]. Other etiologies for chronic back pain, such as apophyseal ring fractures and Scheuermann disease, may be suggested with radiographs alone [31]. MRI Spine MRI can show edema in the region of the pars interarticularis or adjacent pedicle in spondylolysis with negative radiographs and CT. MRI is especially useful in detection of active spondylolysis and has been positively associated with clinical symptomatology [23,24]. Resolution of signal abnormalities suggests a response to therapy and potential prevention of progression to fracture [22,37]. It remains uncertain whether MRI or bone scan with SPECT is preferred in the evaluation of suspected spondylolysis [38]. Abnormalities on MRI such as apophyseal injuries, spondylolysis, and disc disease have been shown to be associated with back pain in the pediatric athlete [39].