The use of bone scan to investigate back pain in children and adolescents

Children with back pain frequently undergo detailed investigation because o f the perception that a high percentage will have a treatable spinal condit ion. The purposes of this study was (i) to determine the percentage of chil dren with disabling back pain presenting to our institution who had a diagn osis (i.e., to explain their back pain), (ii) to evaluate the clinical mark ers that should alert clinicians to underlying pathology, (iii) and to dete rmine the prognosis of children with back pain and no specific diagnosis. T his study was a retrospective analysis of consecutive children undergoing s ingle-photon emission computed tomography for a primary complaint of back p ain. Data collection included chart review, radiographic analysis, and clin ical follow-up with the Roland and Morris scale for pain and disability. Tw o hundred and seventeen patients with an average age of 13 years (range, 2. 7-17.7) were reviewed on average 4.4 years after presentation (range, 1.1-7 .2 years). One hundred and seventy children (78.3%) had no specific diagnos is to explain their back pain, 15 children (6.9%) had spondylosis, 10 child ren (4.6%) had tumor, and the remaining 22 children (10.1%) had various dia gnoses including infection, Scheuermann's kyphosis, herniated disc, kidney disease, facet arthritis, degenerative disc disease, congenital anomalies, and tethered cord. Factors associated with positive diagnoses were constant pain and male gender. Night pain, constant pain, and duration of symptoms <3 months were associated with the diagnosis of a tumor. Although the major ity of children presenting with persistent back pain had no demonstrable ca use, of 132 contactable patients 94 (71%) had persisting pain at the time o f clinical follow-up. In conclusion. the majority of children with disablin g back pain has no demonstrable cause and the majority will continue to hav e pain years after initial presentation.