The workup of low back pain in children often results in overimaging so as not to miss organic back pain. The primary goal
of this study was to identify which combination of imaging modalities provides the most sensitive and specific screening protocol
for children with low back pain. Medical records from 100 consecutive patients between 2 and 18 years of age presenting with
low back pain, without night pain or constitutional symptoms, were evaluated. A hyperextension test combined with a radiograph
showed a negative predictive value of 0.81 and sensitivity of 0.90. The addition of a bone scan was highly effective in achieving
good negative predictive value and sensitivity. Bone scans had perfect negative predictive value and sensitivity when symptom
duration was less than 6 weeks. We identified a set of factors that is highly predictive for distinguishing organic back pain
from mechanical back pain. Painless hyperextension combined with negative anteroposterior, lateral, and oblique lumbar radiographs
and magnetic resonance images predicts mechanical back pain. For patients with nonneurologic back pain of less than 6 weeks
duration, bone scan is the most useful screening test because it is accurate, accessible, inexpensive, and unlikely to require
sedation.
Level of Evidence: Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.
Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest,
patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations
were conducted in conformity with ethical principles of research, and that informed consent was obtained.