Diagnostic Imaging Pathways - Paediatric, Neck or Back Pain

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Population Covered By The Guidance

This pathway provides guidance on imaging children with neck or back pain.

Date reviewed: July 2014

Date of next review: 2017/2018

Published: July 2014

Quick User Guide

Move the mouse cursor over the PINK text boxes inside the flow chart to bring up a pop up box with salient points.
Clicking on the PINK text box will bring up the full text.
The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.

No radiation None 0
Minimal radiation Minimal < 1 millisieverts
Low radiation Low 1-5 mSv
Medium radiation Medium 5-10 mSv
High radiation High >10 mSv


Pathway Diagram


Image Gallery

Note: Images coming soon

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Teaching Points


Plain Radiography


Magnetic Resonance Imaging (MRI)


Nuclear Medicine Scans


Computed Tomography (CT)



References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document

  1. Haldeman S, Carroll L, Cassidy JD. Findings from the bone and joint decade 2000 to 2010 task force on neck pain and its associated disorders. J Occup Environ Med. 2010;52(4):424-7. (Level II evidence)
  2. Rodriguez DP, Poussaint TY. Imaging of back pain in children. AJNR Am J Neuroradiol. 2010;31(5):787-802. (Review article)
  3. Kjaer P. Wedderkopp N. Korsholm L. Leboeuf-Yde C. Prevalence and tracking of back pain from childhood to adolescence. BMC Musculoskelet Disord. 2011;12:98. (Level III evidence)
  4. Booth TN. Cervical spine evaluation in pediatric trauma. AJR Am J Roentgenol. 2012;198(5):W417-25. (Review article)
  5. Feldman DS, Straight JJ, Badra MI, Mohaideen A, Madan SS. Evaluation of an algorithmic approach to pediatric back pain. J Pediatr Orthop. 2006;26(3):353-7. (Level III evidence)
  6. Jones GT, Macfarlane GJ. Epidemiology of low back pain in children and adolescents. Arch Dis Child. 2005;90(3):312-6. (Review article)
  7. Bernstein RM, Cozen H. Evaluation of back pain in children and adolescents. Am Fam Physician. 2007;76(11):1669-76. (Review article)
  8. Curtis C, d'Hemecourt P. Diagnosis and management of back pain in adolescents. Adolesc Med State Art Rev. 2007;18(1):140-64, x. (Review article)
  9. Rubinstein SM, van Tulder M. A best-evidence review of diagnostic procedures for neck and low-back pain. Best Pract Res Clin Rheumatol. 2008;22(3):471-82. (Level II evidence)
  10. Davis PJ, Williams HJ. The investigation and management of back pain in children. Arch Dis Child Educ Pract Ed. 2008;93(3):73-83. (Review article)
  11. Dunn AJ, Campbell RS, Mayor PE, Rees D. Radiological findings and healing patterns of incomplete stress fractures of the pars interarticularis. Skeletal Radiol. 2008;37(5):443-50. (Level III evidence)
  12. Holmes JF, Mirvis SE, Panacek EA, Hoffman JR, Mower WR, Velmahos GC. NEXUS Group. Variability in computed tomography and magnetic resonance imaging in patients with cervical spine injuries. J Trauma. 2002;53(3):524-9; discussion 530. (Level III evidence)
  13. Jarvik JG, Deyo RA. Diagnostic evaluation of low back pain with emphasis on imaging. Ann Intern Med. 2002;137:586-97. (Level I evidence)
  14. Ganiyusufoglu AK, Onat L, Karatoprak O, Enercan M, Hamzaoglu A. Diagnostic accuracy of magnetic resonance imaging versus computed tomography in stress fractures of the lumbar spine. Clin Radiol. 2010;65(11):902-7. (Level III evidence)
  15. Klein GR, Vaccaro AR, Albert TJ, Schweitzer M, Deely D, Karasick D, Cotler J. Efficacy of magnetic resonance imaging in the evaluation of posterior cervical spine fractures. Spine. 1999;24:771-4. (Level III evidence)
  16. Tilt L, Babineau J, Fenster D, Ahmad F, Roskind CG. Blunt cervical spine injury in children. Curr Opin Pediatr. 2012;24(3):301-6. (Review article)
  17. Holmes JK, Akkinepalli R. Computed tomography versus plain radiography to screen for cervical spine injury: a meta-analysis. J Trauma. 2005;58:902-5. (Level I / II evidence)
  18. Pharisa C, Lutz N, Roback MG, Gehri M. Neck complaints in the pediatric emergency department: a consecutive case series of 170 children. Pediatr Emerg Care. 2009;25(12):823-6. (Level III evidence)
  19. Jeffries LJ, Milanese SF, Grimmer-Somers KA. Epidemiology of adolescent spinal pain: a systematic overview of the research literature. Spine (Phila Pa 1976). 2007;32(23):2630-7. (Level II evidence)

{tab=Information for Consumers}

Information for Consumers

Information from this website

Information from the Royal Australian and New Zealand College of Radiologists’ website

Consent to Procedure or Treatment

Radiation Risks of X-rays and Scans

Computed Tomography (CT)

Magnetic Resonance Imaging (MRI)

Plain Radiography (X-ray)

Computed Tomography (CT)

Magnetic Resonance Imaging (MRI)

Plain Radiography/X-rays

Radiation Risk of Medical Imaging for Adults and Children

Making Your Child's Test or Procedure Less Stressful



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