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Imaging in Pediatric Low Back Pain: AJR Expert Panel Narrative Review
Rupa Radhakrishnan1,2, Asha Sarma3, Jeremy Y Jones4
1Present affiliation: Department of Radiology, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA 15224.
Insights
Pediatric low back pain (LBP) evaluation requires judicious use of imaging, primarily MRI. Radiologists’ awareness of key imaging findings aids timely diagnosis and treatment of serious conditions, reducing morbidity.
Area of Science:
- Radiology
- Pediatric Imaging
- Musculoskeletal Disorders
Background:
- Low back pain (LBP) is a common presentation in children without acute trauma.
- While often benign, LBP can signal serious underlying conditions like infections, neoplasms, or inflammatory diseases requiring prompt management.
- Magnetic Resonance Imaging (MRI) is the primary imaging modality for evaluating pediatric LBP.
Purpose of the Study:
- To provide an overview of appropriate imaging use for pediatric LBP.
- To highlight the utility of different imaging modalities and techniques.
- To review imaging features of common and critical causes of pediatric LBP.
Main Methods:
- This is an AJR Expert Panel Narrative Review.
- The review synthesizes current knowledge on imaging for pediatric LBP.
- It focuses on appropriate use, optimal techniques, and key imaging findings.
Main Results:
- Increased radiologist awareness of imaging findings can expedite diagnosis and treatment.
- Judicious use of advanced imaging is crucial to avoid unnecessary costs and risks.
- The review covers classic imaging features of common and uncommon pediatric LBP causes.
Conclusions:
- Appropriate imaging selection and interpretation are vital for managing pediatric LBP.
- Radiologist expertise in pediatric-specific organic causes of LBP is essential.
- Timely diagnosis through effective imaging reduces patient morbidity and mortality.
Abstract:
Low back pain (LBP) in the absence of acute trauma is a common pediatric presentation. Although LBP is frequently due to benign causes, red-flag signs and symptoms may indicate more serious causes, including infections, neoplasms, and inflammatory conditions, that necessitate more urgent management. MRI is the mainstay imaging test for the evaluation of pediatric LBP, and increased radiologist awareness of the imaging findings of key causes of pediatric LBP can expedite diagnosis and treatment and thereby decrease morbidity and mortality. Although imaging plays a key role in the diagnostic workup of LBP in the pediatric age group, imaging must be used judiciously, as excessive advanced imaging may be associated with unnecessary costs and additional patient risk without substantial positive effect on clinical outcome. In this AJR Expert Panel Narrative Review, we provide an overview of the appropriate use of imaging for the workup of a child presenting with LBP, highlighting the utility of different modalities, optimal imaging techniques, and advanced methods that may aid problem solving. We also review the classic imaging features of common and critical causes of LBP in this age group, focusing on pediatric-specific organic causes while addressing certain uncommon diagnoses that radiologists should not miss.
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