A Prospective Evaluation of Diagnostic Modalities in Pediatric Back Pain

It is commonly taught that pediatric back pain frequently has an identifiable diagnosis. This study prospectively examines the rate of diagnosis as well as the value of diagnostic studies for pediatric back pain.

A prospective algorithm was created for the evaluation of idiopathic back pain in children. The endpoint was considered to be either definitive diagnosis, or no diagnosis and no clinical changes over a two year period.

Sixty-six patients were enrolled. Fifty-three patients ended with no diagnosis. Five patients were diagnosed with spondylolysis and two with Scheuermann’s disease. Three females had elevated ESR’s with negative HLA-B27 markers. Three patients with normal plain films had mild disc bulges on MRI.

Eighty percent of the patients ended with no definitive diagnosis. After negative plain films, ESR, and neurologic exam, the addition of MRI or bone scan was of little diagnostic value. The likelihood of serious pathology was less than previously reported.