Back pain and scoliosis in children: When to image, what to consider

When addressing persistent back pain in a child, it is imperative to rule out any underlying medical condition. A delay in reaching a diagnosis can lead to unfavorable clinical outcomes. Healthcare practitioners should remain attentive to specific warning signs, often referred to as "red flags," which include factors such as back pain in prepubertal children, a gradual escalation of symptoms, the presence of neurological abnormalities, a history of malignancy or exposure to tuberculosis, recurring or worsening pain, restricted range of motion, alterations in posture, or the development of a limp, among others.
A study published in The Neuroradiology Journal highlights that the identification of these "red flags" or any abnormal neurological findings should trigger an immediate decision for diagnostic imaging. Among the initial imaging methods employed for the assessment of scoliosis and back pain, plain radiographs hold precedence. The measurement of the Cobb angle remains the primary benchmark for gauging the extent of scoliosis. While CT scans are widely acknowledged as the gold standard for appraising osseous structures and acute trauma, as well as for monitoring the progress of fracture healing, they might not always detect early or subtle stress-related injuries.
For a direct visualization of the spinal cord, ligaments, and intervertebral discs, magnetic resonance imaging (MRI) stands as the sole modality. It proves particularly valuable in the comprehensive evaluation of paraspinal or intraspinal conditions. In instances where plain radiographs, CT scans, and/or MRIs yield negative results despite persistent back pain, nuclear medicine imaging can provide additional insights.