Abstract
We undertook a review of bone scans requested for children to determine the usefulness of isotope bone scintigraphy in investigating skeletal pain in this population.
We reviewed the bone scans, plain radiographs and clinical notes of consecutive children under 16 years of age presenting to children’s orthopaedic surgeons at two teaching hospitals in one city.
There were 229 patients, of which 40% were boys and 60% girls. They had and average age of 11 years. 139 were investigated for back pain and 90 for skeletal pain in the appendicular skeleton. They were investigated for a variety of conditions including idiopathic back and skeletal pain, scoliosis, Scheuermann’s disease, spondylolysis and stress fractures, osteomyelitis and post-operative pain.
There were positive scans in 4 out of 78 patients with idiopathic back pain, 1 of 25 patients with scoliosis and 1 out of 5 with spondylolysis and 11 out of 70 with idiopathic skeletal pain.
Of all patients with back pain the management was altered in only 3 children. Of all those investigated for appendicular skeletal pain the management was altered in 6 children.
Conclusion: Isotope bone scanning is a low yield, and non-specific investigation that imparts a significant dose of radiation to the patient. It should not be used as a first line investigation for idiopathic back or skeletal pain in children. Other tools such as MRI should be considered initially.
The role of isotope bone scanning in the investigation of skeletal and joint pain in children should be reevaluated.
The abstracts were prepared by Mr N. M. P. Clarke. Correspondence should be addressed to him at the British Orthopaedic Association, Royal College of Surgeons, 35-43 Lincoln’s Inn Fields, London WC2A 3PN.
