Intervertebral disc space inflammation in children

Abstract

Discitis in children commonly presents with fever, back pain, irritability, and an inability to walk. An elevated ESR and characteristic changes on plain X-rays or bone scan are sufficient for diagnosis, but MRI is more sensitive and more specific, and it shows pathologic changes earlier. Intravenous antibiotics are administered when cultures of the disc space are positive, but in more than half of the cases, no organism can be grown. Symptoms are alleviated with bed-rest or external orthoses, but neither the duration nor the kind of symptomatic treatment influences outcome.

Klebsiella Discitis in a 15-Year-Old Male Diagnosed With Plasma Microbial Cell-Free DNA Next-Generation Sequencing Test: A Case Report

“…X-ray evaluation is useful in the identification of alignment abnormalities or when the clinical picture is not specific for discitis or CNS pathology [2]. Because of the low yield, potential morbidity, and need for conscious sedation or general anesthesia in the young child, a biopsy is not routinely recommended for the evaluation of the child with discitis [2]. A biopsy is reserved for patients who do not respond to empiric intravenous anti-staphylococcal antibiotics because an unusual or highly virulent organism may be present [17].…”

“…These infections encompass a broad range of conditions, from discitis to osteomyelitis and spinal epidural and intramedullary abscesses [1]. Discitis is the infectious or inflammatory disease of the intervertebral disc space, which is usually self-limiting in children [2]. Diagnosis is often delayed, especially in young children, as the initial symptoms may mimic other processes such as septic arthritis, appendicitis, or meningitis [3].…”

Pediatric Spontaneous Discitis: A Case Report

“…It is still an uncommon diagnosis and mimics neuromuscular disorders, Scheuermann disease, pyelonephritis, appendicitis, septic arthritis, osteomyelitis, and meningitis. 8 Bacterial infection can produce secondary reactive inflammatory changes of a disc space or infection of the space itself. 2,9 S. aureus appears to be the most common organism.…”

Effects of Intervertebral Disc Infection on the Developing Ovine Spine

“…Diagnosis, therefore, relies largely on plain radiograph, bone scan, computed tomography, or magnetic resonance imaging to detect narrowing of the disc space and erosion of the vertebral endplates. 7 These changes become apparent between 2 and 4 weeks after the onset of symptoms, although persistent disc narrowing in clinically normal patients has been reported up to 5 years after the resolution of symptoms. 3,4,9 Remineralization and sclerosis are seen at the margins of vertebral bodies adjacent to the affected disc after 2 to 3 months.…”

“…4 -8 Erythrocyte sedimentation rate and leukocyte count may be raised, and while blood cultures are usually negative, positive blood cultures have been reported in patients who were symptomatic for less than 6 weeks. 8 Direct microbiological culture of the disc space is negative in 50 to 70% of patients, [3][4][5][6][7][8] and when it is positive, it is usually in the chronic stage of the disease. Diagnosis, therefore, relies largely on plain radiograph, bone scan, computed tomography, or magnetic resonance imaging to detect narrowing of the disc space and erosion of the vertebral endplates.…”