Pediatric emergency medicine trisk 3979 3979
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hamstrings are usually tight, with decreased range of motion on straight leg raise
and flexion of the trunk. Children seldom have motor (10%), sensory (15%), or
reflex (10%) deficits in the legs.
Management/Diagnostic Testing. Plain radiographs are about 75% sensitive for
spondylolysis and should include AP and lateral views. Oblique views do not add
to the diagnostic sensitivity. Spondylolisthesis can be diagnosed on the lateral
view, and the degree of displacement can be quantitated relative to the width of
the vertebral body ( Fig. 121.18 ). A bone scan or MRI in children with chronic
back pain and normal plain radiographs can identify some additional cases of
spondylolysis in its early stages, when conservative therapy can result in bony
union.
