Diagnostic Algorithm

Once a problem list and differential diagnosis have been generated, they should be used to guide the ordering of the proper laboratory tests, if necessary. The presence of an elevated white blood cell count and / or sedimentation rate should suggest the presence of an inflammatory process.

Once the lab test results have been obtained, they should be used to guide the ordering of the proper imaging tests, if necessary. The first imaging test in the child with back pain is a plain film of the spine, including Anterior-Posterior (AP) and lateral views. If the plain film of the spine is positive for a lesion, the lesion should be further investigated with computed tomography (CT) with thin slices. If the plain film of the spine is negative, a bone scan should be performed with tomographic imaging. Tomographic imaging when done with a bone scan increases the sensitivity of the bone scan. If the bone scan demonstrates a lesion, it should be further investigated with computed tomography with thin slices. If the bone scan is negative, a magnetic resonance imaging (MRI) exam of the spine may be done, but it has a low probability of success, unless the lesion is suspected to be a herniated disk. If the MRI demonstrates a lesion, it should be further investigated with computed tomography with thin slices.

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