Bone Scan Whole Body with SPECT or SPECT/CT Complete Spine SPECT bone scan is not indicated for evaluation of patients with back pain and no red flags. Myelography and Postmyelography CT Spine This examination is not indicated for evaluation of patients with back pain and no red flags. Variant 2: Child. Back pain with 1 or more of the following clinical red flags: constant pain, night pain, radicular pain, pain lasting >4 weeks, abnormal neurologic examination. Initial imaging evaluation. Radiographs Radiographs of the cervical, thoracic, or lumbar spine are a useful initial diagnostic imaging procedure for evaluation of back pain in children. Radiographs can demonstrate findings that lead to the diagnosis in up to 24% of children [1,4,5]. Anterior-posterior radiographs are typically sufficient, with additional views only adding to the radiation dose without increase in diagnostic yield. Collimation to the area of concern may aid in the diagnosis [6,9]. Pathologic conditions that can be diagnosed on radiographs include spondylolysis, scoliosis, Scheuermann disease, and bone tumors [1,4,5]. In children with back pain and clinical red flags, negative radiographs are not considered adequate to exclude pathology and additional advanced imaging techniques are required [1,5]. Positive radiographs leading to a specific diagnosis may guide therapy without additional imaging or direct further appropriate imaging evaluation [1,4,5]. MRI Spine Noncontrast MRI of the spine targeted to the region of interest is sensitive for the imaging evaluation of soft- tissue and bony abnormalities associated with pediatric back pain, including paraspinous soft-tissue pathology, disc disease, marrow edema, and intraspinal masses [8,24-26,32]. However, radiographs should be the initial imaging evaluation in most cases. MRI of the total spine may be indicated as the initial evaluation of patients with abnormal neurologic findings.
Back Pain Child PCAs. Bone Scan Whole Body with SPECT or SPECT/CT Complete Spine SPECT bone scan is not indicated for evaluation of patients with back pain and no red flags. Myelography and Postmyelography CT Spine This examination is not indicated for evaluation of patients with back pain and no red flags. Variant 2: Child. Back pain with 1 or more of the following clinical red flags: constant pain, night pain, radicular pain, pain lasting >4 weeks, abnormal neurologic examination. Initial imaging evaluation. Radiographs Radiographs of the cervical, thoracic, or lumbar spine are a useful initial diagnostic imaging procedure for evaluation of back pain in children. Radiographs can demonstrate findings that lead to the diagnosis in up to 24% of children [1,4,5]. Anterior-posterior radiographs are typically sufficient, with additional views only adding to the radiation dose without increase in diagnostic yield. Collimation to the area of concern may aid in the diagnosis [6,9]. Pathologic conditions that can be diagnosed on radiographs include spondylolysis, scoliosis, Scheuermann disease, and bone tumors [1,4,5]. In children with back pain and clinical red flags, negative radiographs are not considered adequate to exclude pathology and additional advanced imaging techniques are required [1,5]. Positive radiographs leading to a specific diagnosis may guide therapy without additional imaging or direct further appropriate imaging evaluation [1,4,5]. MRI Spine Noncontrast MRI of the spine targeted to the region of interest is sensitive for the imaging evaluation of soft- tissue and bony abnormalities associated with pediatric back pain, including paraspinous soft-tissue pathology, disc disease, marrow edema, and intraspinal masses [8,24-26,32]. However, radiographs should be the initial imaging evaluation in most cases. MRI of the total spine may be indicated as the initial evaluation of patients with abnormal neurologic findings.