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Pediatric lumbar spine MRI: structural imaging findings and anatomical variants associated with disc herniation
Şükriye Yılmaz1, Hasan Bulut2, Muhammed Erkan Emrahoğlu3
1Department of Pediatric Radiology, Ankara Etlik City Hospital, Ankara, Turkey. dryavuzer@gmail.com.
Insights
Pediatric lumbar MRI is crucial for identifying structural issues in children with low back pain. Lumbar disc herniation is linked to anatomical variations like lumbosacral transitional vertebrae.
Area of Science:
- Pediatric Radiology
- Spinal Imaging
- Musculoskeletal MRI
Background:
- Pediatric low back pain evaluation requires understanding common MRI findings.
- Lumbar disc herniation (LDH) in children necessitates assessment of associated structural factors.
Purpose of the Study:
- To evaluate clinical indications, imaging findings, and structural factors on pediatric lumbar MRI.
- To focus on non-traumatic low back pain and lumbar disc herniation (LDH) in children.
Main Methods:
- Retrospective review of 1,253 pediatric lumbar MRI exams (ages 0-18).
- Systematic analysis of imaging findings for non-traumatic low back pain.
- Reassessment of lumbosacral transitional vertebrae (LSTV), spondylolysis, and spondylolisthesis in LDH patients, using Castellvi classification for LSTVs.
Main Results:
- Low back pain was the primary indication (51.9%).
- Most exams (62.3%) were normal; common abnormalities included disc protrusion (15.1%), degenerative changes (8.9%), spondylolysis (5.5%), and spondylolisthesis (2.8%).
- LDH occurred mainly at L5-S1; LSTVs were present in 8% of LDH patients, with higher Castellvi grades significantly associated with LDH (p<0.001).
Conclusions:
- Pediatric lumbar MRI is vital for detecting structural abnormalities, despite most low back pain exams being normal.
- LDH is more prevalent in older adolescents and associated with LSTV and lumbarization.
- Recognizing these anatomical variations is key for accurate diagnosis and management of pediatric low back pain.
Background:
This study aimed to evaluate the clinical indications, imaging findings, and structural factors identified on pediatric lumbar MRI, with a specific focus on non-traumatic low back pain and lumbar disc herniation (LDH).
Materials And Methods:
A retrospective review was conducted of 1,253 lumbar MRI examinations performed in pediatric patients aged 0-18 years between November 2022 and March 2024. Clinical indications were documented for all patients. Imaging findings were systematically analyzed in children presenting with non-traumatic low back pain. In patients diagnosed with LDH, the presence of lumbosacral transitional vertebrae (LSTV), spondylolysis, and spondylolisthesis was reassessed. LSTVs were categorized using the Castellvi classification.
Results:
Low back pain was the most common indication for MRI (n=650, 51.9%). Among these children, 62.3% had normal examinations. Disc protrusion (15.1%), degenerative disc or endplate changes (8.9%), spondylolysis (5.5%), and spondylolisthesis (2.8%) were the most frequent abnormalities. LDH predominantly occurred at the L5-S1 level. LSTVs were identified in 52 patients (8%) with LDH, and higher-grade Castellvi types were significantly associated with LDH (p<0.001). Lumbarization of S1 was observed in 10 LDH patients, typically showing squaring of S1 and prominence of the S1-2 disc space.
Conclusion:
Although most pediatric lumbar MRI examinations performed for low back pain are normal, MRI remains essential for identifying clinically relevant structural abnormalities. LDH is more common in older adolescents and is associated with anatomical variants such as LSTV and lumbarization. Recognition of these variations, combined with adherence to evidence-based imaging recommendations, is crucial for accurate diagnosis and appropriate clinical management in children with low back pain.
