Spinal infections in children: a review

Abstract

Spondylodiscitis affects children aged between two and eight years, and mainly involves the lumbar or lumbosacral spine. Diagnosis is difficult because the symptoms are not very specific and due to the children's difficulty in communicating. Unlike adults, children have vascularised intervertebral discs, which explains the higher incidence of this disease in this age group. C-reactive protein, and blood and urine cultures are important laboratory tests. In most cases, fine needle or traditional biopsy helps identify the pathogen particularly in patients who do not respond to the antibiotic therapy test. Magnetic resonance imaging has high sensitivity and specificity in the investigation of pyogenic infection of the spine, particularly in the early stages, when these changes are not shown in other imaging tests. X-rays can take up to six weeks to show changes. The first radiographic sign of infection is the irregularity of the vertebral endplates in the infection area, followed by their erosion and that of the adjacent bone, decreased disc space, segmental collapse, loss of lordosis (in cases of low back involvement) and ultimately, permanent structural deformity. After eight to twelve weeks, local regeneration occurs, accompanied by bone sclerosis arising from the formation of new trabecular bone, replacing the necrotic cancellous bone. Effective treatment often leads to bone fusion of the affected disc space. However, when no therapy is adopted, total vertebral collapse can occur. The treatment involves immobilisation, antibiotic therapy, and surgical decompression in more advanced cases.

A special case of lower back pain in a 3-year-old girl

“…At MRI this patient showed diffuse involvement of all the three anatomical districts of the lumbar vertebrae: disc, bone and paravertebral soft tissues 13 20…”

“…Physical examination showed mild lumbar spine stiffness, gross restriction of lumbar movements and difficulty in walking. The back pain was exacerbated by movements and the patient was unable to bend over to pick up a little toy and showed irritation of the hips when held in extension (log-roll test) 13. Neurological examination showed no signs of meningism and showed a normal lower tendon reflexes.…”

“…In children, diagnosis of infective vertebral spondylodiscitis could be delayed because back pain is often related to traumatism 1 2 13…”

“…The main target bone in Salmonella osteomyelitis is unknown but, in general, the vertebra is rarely infected in the paediatric age 3 13…”

Infections of the spine are still a great problem

“…De Moraes Barros Fucs et al [23] present a review article focused on children's spondylodiscitis, a rare disease of unknown incidence. Cheung and Luk, Zarghooni et al and Guerado and Cervan [24][25][26] each wrote a review article about the incidence and treatment of spondylodiscitis in adults, Cheung and Luk [24] describe in detail the clinical and diagnostic protocols to follow in these cases, Zarghooni et al [25] present a treatment algorithm and Guerado and Cervan [26] discusses surgical controversies.…”