Children with back pain – a radiologist’s approach

Abstract

IntroductionThe aim of the study was to analyse magnetic resonance imaging (MRI) of paediatric patients referred because of back pain.Material and methodsThe retrospective analysis included the medical records of 328 patients referred in 2020-2022 to the Department of Paediatric Radiology for spine examination. The criterion for inclusion in the analysed group was back pain as the dominant symptom. This symptom occurred in 20% (68 patients) of referrals for MRI examinations. The examination was performed with the 3T Magnetom Spectra.ResultsIn 68 patients aged 2 to 17 years, with back pain as the first diagnosis, 53% (36 patients – 16 girls and 20 boys) showed abnormalities. The rest of the tests were assessed as normal. Among the patients with an abnormal MR image, the largest group were children with degenerative changes diagnosed: 10 children (28%) aged 13-17 years. In 9 patients (25%) aged 2-16 years the final diagnosis qualified the patients to the group of oncological diagnoses. Another group of 7 (19%) patients, aged 6-14 years, comprised children diagnosed with inflammation. The group of 5 patients, aged 3-17 years, presented symptoms most likely related to the trauma. One 7-year-old boy was diagnosed with large calcifications within the intervertebral disc.ConclusionsBack pain, with accompanying neurological symptoms, should not be underestimated. Although in most clinical situations the MR image is normal, in the case of persistent symptoms and neurological abnormalities confirmed by the clinician, extending the diagnostics with MR imaging should be considered. This imaging can accelerate the correct diagnostic path or make a very precise diagnosis.

Clinical presentation and imaging findings in juvenile-onset back pain: a ten-year hospital-based retrospective analysis in Douala (Cameroon)

“…To the best of our knowledge, this is the first study to present a panoramic view of the clinical characteristics (obtained after a comprehensive clinical examination summarized in the medical record) and presumed etiologies (after spine imaging) of JOBP in children and adolescents in an African setting. Although not exhaustive, the imaging findings observed in this study are broadly in line with the data available, ranging from “evil” etiologies such as spondylodiscitis or neoplasia to “non-specific” etiologies ( 3 , 4 , 7 , 24 , 25 ). Despite this significant strength of our study, there are several limitations.…”

“…In fact, in a recent study aimed at determining the natural history of disc changes from childhood to early adulthood and the possible association of these changes with low back pain, the authors showed that changes in the intervertebral disc signal on MRI were not associated with the presence of low back pain in childhood, adolescence and adulthood ( 26 ). However, MRI is increasingly used as a first-line imaging modality when at least one red flag is present and severe pathology is suspected in a child with back pain ( 11 , 25 ). There is also an ambiguous relationship between scoliosis and back pain.…”