Most cases of low back pain in children will get better with conservative management and do not need to be diagnosed with radiographic studies, which exposes them to too much radiation, says a Medscape Medical News article based on study results presented last week at the American Academy of Pediatrics (AAP) 2011 National Conference and Exhibition.
Denis Drummond, MD, from the Children's Hospital of Philadelphia, Pennsylvania, and his team retrospectively reviewed the records of 2,846 children aged 10 to 19 years who were seen at their institution with low back pain between 2000 and 2008. Most (63%) were female, and the average age was 14 years.
In 79% of the patients, the cause of their low back pain went undiagnosed. Over 90% had 3 or fewer office visits. Spondylolysis, which was diagnosed in 272 patients, was found by plain radiography in 234 patients, by bone scanning in 34 patients, and by computed tomography (CT) in 4 patients.
Two-view and 4-view radiography was equally sensitive in diagnosing spondylolysis. The sensitivity of 2-view was 78%, and that of 4-view was 72%.
The researchers also found that bone scans delivered significantly more radiation than both CT and 2- and 4-view radiography.
"Our message is try and treat the low back pain conservatively," Drummond told Medscape. "If you want, you can do a 2-view x-ray at the first visit or else put them on physical therapy, and be patient. If they are 50% to 60% improved when you see them in 6 weeks, you're probably on the right track. If the pain is all gone at 3 months, get them ready to go back to sports or usual activities. If there is just as much pain at 6 weeks, go back to the old system of more investigation, but the majority will get better by then."
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