If the clinical history, physical examination, and radiographs do not lead to any specific diagnosis, MRI is advocated as the next diagnostic exam because of its high sensitivity to depict the spinal and paraspinal soft tissues, disc and vertebral abnormalities associated to back pain ( 5).Ĭongenital alterations of the spine can be simple, when there is no associated spinal deformity or have little or no clinical consequence, or complex, when associated with serious deformities such as kyphosis, lordosis or scoliosis, or have neurologic implications ( 10). Finally, when specific causes of back pain (e.g., tumour or infection) are suspected, radiographs have low sensitivity and can often miss subtle findings ( 6). Studies using MRI reported a greater frequency of disc pathology undetected by radiography in children ( 5). Regarding disc pathology, radiography is not sensitive to early changes or disc displacement. Radiographs also play a key role in the diagnosis and management of abnormal spine curvature, including scoliosis and kyphosis. Anterior-posterior and lateral radiographs showed a sensitivity of 77.6% for the detection of spondylolysis ( 9). The most common diagnoses are spondylolysis, spondylolisthesis, Scheuermann’s kyphosis, indirect signs of disc pathology, infectious and neoplastic conditions ( 5, 7). However, in patients with an underlying pathology confirmed by other imaging methods, radiographs showed abnormalities in 26–76% of cases, helping therapy guidance or directing further imaging studies ( 6- 8). In some reported studies, radiograph demonstrated abnormalities in approximately 8–13% of paediatric patients with back pain ( 5- 7). When persistent pain or red flags are present (e.g., fever, trauma, history of malignancy), radiography is still considered the first imaging modality. Therefore, in pain of short duration and no red flags, no imaging is indicated ( 5). As with adults, non-specific pain is the most common cause of back pain. In children with back pain, algorithms have been developed to avoid unnecessary radiation exposure ( 4, 5). Finally, back pain may be secondary to specific causes, such as infection, inflammatory or tumor conditions in this group, radiographs are still recommended to evaluate young patients for ankylosing spondylitis ( 3). Flexion and extension radiographs may also be useful in assessing spinal stability. In this case, radiographs are recommended as the initial imaging study in patients with history of low-energy trauma and in patients with suspicion of vertebral compression fracture, such as osteoporotic patients or those receiving steroids. Mechanical back pain is considered the second most prevalent cause (27%) and includes degenerative disorders of the spine, alignment abnormalities and vertebral fractures. In this setting, no imaging studies are recommended ( 2).
Leaving aside extraspinal causes, the most frequent origin of spinal pain is classified as “non-specific” (70%) because the specific nociceptive source cannot be identified, although it is supposedly related to sprain and/or strain of the soft tissues ( 1). General indications for spine radiographs The aim of this narrative review is to review the diagnostic findings that radiography may provide in the study of spinal disorders and their role in patient management. Although radiography in the digital format remains as one of the most frequently employed techniques in the study of spinal pain, both its role and importance have greatly changed with the widespread use of CT and MRI.īecause CT and MRI have displaced radiography in the study of many spinal conditions, radiographic signs of spinal conditions have become increasingly less studied and thus less known among clinicians and radiologists. Paradoxically, clinicians and radiologists are losing their interest in interpreting radiographs, relying more in the source of information provided by tomographic techniques, such as computed tomography (CT) and magnetic resonance imaging (MRI). The simplest and most accessible technique in the department of radiology is conventional radiography. Keywords: Spine radiography back pain spinal disorder spinal curvature osteoporotic fracture Policy of Dealing with Allegations of Research Misconduct.Policy of Screening for Plagiarism Process.