Characteristics, Management and Outcomes of Spondylodiscitis in Children: A Systematic Review

Abstract

Spondylodiscitis (SD) is the concurrent infection of the intervertebral disc and the adjacent vertebral bodies. Currently, there is a substantial lack of structured reviews about this topic. The aim of this study was to systematically review the available literature in order to determine the main features of pediatric SD. A systematic search of MEDLINE database was performed, according to the PRISMA guideline recommendations. Clinical features, laboratory data, radiological signs, treatments strategies, and outcomes were summarized. Studies’ quality assessments were performed using the JBI Critical Appraisal Checklists. A total of 35 retrospective studies were analyzed and 340 children were identified. The most frequently affected age class was 0.5–4 years. The most affected site was the lumbar spine. The most commonly reported symptoms were back pain (37.97%) and refusal to walk/to stand/to sit (49.79%). The most frequently identified pathogen was Staphylococcus aureus (n = 33). The most used antibiotics were third generation cephalosporins. The intravenous therapy duration range was 1–25 weeks, the oral therapy duration range was 5 days–36 months. Surgery was used in 5.88% of children. In 29 cases clinical sequelae were documented. This study provides the main features of pediatric SD; it also emphasizes the significant gaps in the literature regarding this topic.

Spondylodiscitis in Pediatric Age: A Retrospective Cohort Study

“…In accordance with other studies, 6,12 in our cohort a slight male predominance was found. In larger series, a bimodal age distribution for this condition is reported, 6 while in our study a high peak of incidence in young children (<2 years) was identified, with a median age at diagnosis of 3.2 years.…”

“…In accordance with other studies, 6,12 in our cohort a slight male predominance was found. In larger series, a bimodal age distribution for this condition is reported, 6 while in our study a high peak of incidence in young children (<2 years) was identified, with a median age at diagnosis of 3.2 years. By dividing our cohort into 2 age subgroups, distinct clinical pictures and pathophysiological mechanisms for each were observed: older children showed a typical clinical pattern characterized by higher fever and back pain, whereas in the younger ones, symptoms were subtle and mainly included irritability, refusal to bear weight, difficulty in changing position and deterioration of general conditions.…”

Spondylodiscitis in Children: A Retrospective Study and Comparison With Non-vertebral Osteomyelitis

“…To evaluate osteonecrosis or other bony sequelae and to guide the surgical intervention, CT scans are mandatory in PSD. Regarding the antibiotic therapy, most authors agree upon long periods—up to 6 weeks—of antibiotic therapy and bed rest ( 3 , 15 ). This treatment should lead to complete sterilization of the infected site, as to allow a “clean” surgery when needed.…”

“…Thus, the current pediatric practice is derived from the management of adult spondylodiscitis (12)(13)(14) and relies upon the experience of the treating clinicians. After clinical suspicion of PSD is risen, contrast-enhanced magnetic resonance imaging is the investigation of choice for the description of the infected site location and extension (3). As this is also the most sensitive technique to detect spinal involvement, we recommend its use both in the acute phase and in the follow-up of patients with PSD.…”

“…In the past, these two conditions were distinguished according to bone involvement, with the former found to be more common in children younger than 5 years owing to the relative abundance of blood vessels both in the cartilaginous vertebral endplate and within the growing vertebral body, where microorganisms or emboli are cleared by the several arterial anastomoses ( 1 , 2 ). With the advent of Magnetic Resonance Imaging (MRI), early inflammatory edema of the disk-adjacent bones became evident and the distinction between infectious discitis and vertebral osteomyelitis became more subtle, with the two being now considered different stages of the same pathological process ( 3 ). However, recent data showed an age-dependent distribution of both the symptoms and etiology of this disease that may revalorize the old anatomical classification from a clinical point of view ( 4 ).…”