Laboratory evaluation with a complete blood count and sedimentation rate may be of use to evaluate for a systemic etiology [12-14]. Clinical and laboratory findings suggesting an infectious or neoplastic etiology should be imaged without delay. The presence of constant pain, night pain, and radicular pain, alone or in combination, lasting for 4 weeks or more, constitute clinical red flags that should prompt further imaging. An abnormal neurologic examination should prompt immediate imaging [1,4,5]. Overview of Imaging Modalities Radiographs Radiographs of the symptomatic region are a useful initial imaging modality, as they are readily available and may lead to a diagnosis in a significant number of patients [4]. Vertebral alignment, spinal curvature, and disc height can easily be ascertained using radiographs. The presence of spondylolysis, Scheuermann disease, and primary bone tumors may be suggested on radiographs and direct any further imaging [4,15,16]. Oblique views of the lumbar spine have been shown to double the radiation dose delivered without any additional helpful information beyond the standard frontal and lateral views [6,9]. Radiographs are insensitive to paraspinal and intraspinal soft-tissue masses. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Magnetic Resonance Imaging MRI without contrast has been shown to be an effective screening tool in evaluating pediatric patients with certain red-flag clinical presentations [1,5]. In young patients, the MRI examination may need to be performed under sedation. MRI is the only modality that directly visualizes the spinal cord, ligaments, and intervertebral discs.
Back Pain Child PCAs. Laboratory evaluation with a complete blood count and sedimentation rate may be of use to evaluate for a systemic etiology [12-14]. Clinical and laboratory findings suggesting an infectious or neoplastic etiology should be imaged without delay. The presence of constant pain, night pain, and radicular pain, alone or in combination, lasting for 4 weeks or more, constitute clinical red flags that should prompt further imaging. An abnormal neurologic examination should prompt immediate imaging [1,4,5]. Overview of Imaging Modalities Radiographs Radiographs of the symptomatic region are a useful initial imaging modality, as they are readily available and may lead to a diagnosis in a significant number of patients [4]. Vertebral alignment, spinal curvature, and disc height can easily be ascertained using radiographs. The presence of spondylolysis, Scheuermann disease, and primary bone tumors may be suggested on radiographs and direct any further imaging [4,15,16]. Oblique views of the lumbar spine have been shown to double the radiation dose delivered without any additional helpful information beyond the standard frontal and lateral views [6,9]. Radiographs are insensitive to paraspinal and intraspinal soft-tissue masses. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Magnetic Resonance Imaging MRI without contrast has been shown to be an effective screening tool in evaluating pediatric patients with certain red-flag clinical presentations [1,5]. In young patients, the MRI examination may need to be performed under sedation. MRI is the only modality that directly visualizes the spinal cord, ligaments, and intervertebral discs.