Question of the Month - November 2019 - Society for Pediatric Pain Medicine

Written by Ben Ekstrom MD, FAAP
Center for Pain Relief

A 15-year-old, otherwise healthy female gymnast presents to the pediatric chronic pain clinic with a six-month history of low back pain. The pain has been getting progressively worse over time and is not associated with any radicular symptoms. There was no significant injury prior to the onset of pain. She has been missing practices with increasing frequency. Her mood and academic performance are beginning to be impacted by the back pain. You suspect she may have developed lumbar spondylolysis. With regards to this disease, which of the following is NOT true?

A. Plain film oblique radiographs, magnetic resonance (MR) imaging, radionucleotide bone scan, and axial helical computed tomography (CT) can all detect spondylolysis.

B. Surgical stabilization may be needed for high grade spondylolisthesis.

C. Sports which require repeated hyperextension, such as gymnastics, football, and weight lifting, are associated with increased risk of pars interarticularis fracture.

D. This patient should be referred immediately to physical therapy for active lumbar extension resistive/strengthening exercises.

E. Imaging should be considered in all children who have had back pain for more than 1 month, or in whom signs or symptoms of serious pathology are present.

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Question of the Month – November 2019

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