Imaging in Pediatric Low Back Pain: AJR Expert Panel Narrative Review

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.