What Do We Know about Spondylodiscitis in Children? A Retrospective Study

Yagdiran, Ayla; Meyer‐Schwickerath, Charlotte; Wolpers, Raphael; Otto-Lambertz, Christina; Mehler, Katrin; Oberthür, André; Kernich, Nikolaus; Eysel, Peer; Jung, Norma; Zarghooni, Kourosh

doi:10.3390/children9081103

Cited by 3 publications

(1 citation statement)

References 20 publications

(45 reference statements)

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“…Tuberculosis (TB) often impacts immunosuppressed, homeless, and alcoholic individuals, prisoners, intravenous drug users, and immigrants from Sub-Saharan Africa, India, and Southeast Asia [ 10 ]. Children with SD commonly present with difficulty walking, with limping and lumbar pain [ 4 , 11 ]. Our patient presented with a 3-week history of refusal to walk with frequent episodes of crying, which signify back pain, with no documented history of fever.…”

Section: Discussionmentioning

confidence: 99%

Early Diagnosis and Successful Empirical Treatment of L1-L2 Spondylodiscitis in a 21-Month-Old Girl: A Case Report

Janahi,

Ashoor,

Alshaikh

et al. 2024

Am J Case Rep

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Patient: Female, 2-year-old Final Diagnosis: Spondylitis Symptoms: Inability to walk with conistipation Clinical Procedure: Lumbar MRI Specialty: Neurology Objective: Rare disease Background: Infantile spondylodiscitis is a rare condition with a varied clinical presentation. Microbial infection may not always be identified, but early diagnosis and management are required to prevent long-term and irreversible complications, including spinal deformities and vertebral instability. Case Report: This report is of a 21-month-old girl with a 3-week history of difficulty in walking and constipation due to L1-L2 spondylodiscitis following a gluteal skin burn. The family had sought medical advice multiple times, but results of all investigations were unremarkable. Her initial spine X-ray was negative but her spine magnetic resonance imaging (MRI) showed a picture suggestive of spondylodiscitis, which then responded to empiric treatment with broad-spectrum antibiotics. The patient showed complete resolution of clinical symptoms and her bowel habits came back to normal after 6 months of complete antibiotics treatment. Her repeat spine MRI showed a significant improvement of her spondylodiscitis. Conclusions: This report has highlighted the importance of rapid diagnosis and management of infantile spondylodiscitis and the challenging approach to treatment when no infectious organism can be identified, as well as the early initiation of antibiotics therapy when appropriate in pediatric patients to avoid serious neurological complications associated with spondylodiscitis. Thus, it is essential to assess children with refusal to walk, gait problems, or back discomfort, especially when they are associated with high inflammatory markers.

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Section: Discussionmentioning

confidence: 99%

Early Diagnosis and Successful Empirical Treatment of L1-L2 Spondylodiscitis in a 21-Month-Old Girl: A Case Report

Janahi,

Ashoor,

Alshaikh

et al. 2024

Am J Case Rep

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The benefit of antibiotic-combined Mg-hydroxyapatite bone graft substitute over autologous bone for surgical site infection prevention in posterolateral spinal fusion: a retrospective cohort study

Zanotti¹,

Muggiolu²,

Maria

2023

Annals of Medicine &Amp; Surgery

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Study Design: Retrospective cohort study. Objective: The authors’ goal was to clarify whether a bone substitute combined with antibiotics might gain a hold in spinal surgery as a preventive treatment for early infections (EIs). Background: A relatively infrequent but severe complication in spinal surgery is the occurrence of EIs. Methods: The authors retrospectively compared a population undergoing posterolateral fusion with Mg-enriched hydroxyapatite paste mixed with 60 mg rifampicin powder, with a matched population treated with autologous bone without antibiotics. A total of 30 patients from 2020 to 2021 were included in our study. We estimated EI’s relative risk and the number needed to treat. Statistical analyses were performed using the R statistical package v3.4.1 (http://www.r-project.org). Results: No early infections occurred in the population treated with antibiotic-combined bone substitutes, compared with 6.7% of patients treated with autologous bone without antibiotics. The relative risk of EIs was 0.33 (P=.49; 95% CI=0.01–7.58) and the number needed to treat was 15. Conclusions: The results support the hypothesis that combining bone substitutes with antibiotics may decrease the risk of EIs and could be a viable option to improve spinal surgery outcomes. However, a larger sample size would be needed to confirm the benefit of rifampicin-combined Mg-enriched hydroxyapatite substitutes over autologous bone for surgical site infection prevention. Level of Evidence: Level 3.

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Understanding the management of pediatric spondylodiscitis based on existing literature; a systematic review

Lashkarbolouk,

Mazandarani,

Ilharreborde

et al. 2023

BMC Pediatr

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Background Spondylodiscitis (SD), a rare disease in children, poses diagnostic challenges due to non-specific presenting symptoms, scarcity in incidence, and difficulty expressing pain in non-verbal children. Method A comprehensive search was conducted on three databases, including PubMed/Medline, Web of Science, and Scopus until March 2023. The inclusion criteria were studies that investigated the clinical characteristics, treatment, and complications of children’s spondylodiscitis. Full text of cross-sectional and cohort studies were added. The quality assessment of cohort studies was conducted using the Newcastle-Ottawa Quality Assessment Scale. The search, screening, and data extraction were performed by two researchers independently. Result Clinical manifestations of discitis in children are nonspecific, such as back pain, fever, reduced ability or inability to walk or sit, limping, and reduced range of movements. The mean delay in the time of diagnosis was 4.8 weeks. The most affected site of all the studies was the lumbar spine. 94% of studies reported increased inflammatory markers such as white blood cell count, C-reactive protein, and erythrocyte sedimentation rate. Less than 30% of patients had positive blood cultures and biopsy findings. The most common microbiological results (64%) were Staphylococcus Aureus and Kingella kingae. In radiographic evaluation, intervertebral disk narrowing, lumbar lordosis reduction, loss of disk height, and destruction of the vertebral body have been reported. In all studies, antibiotic therapy was initiated; in 52% immobilization was employed, and 29% of studies reported surgery was performed, and the follow-up period differed from 1.5 months to 156 months. 94% of studies reported complications such as vertebral body destruction, back pain, kyphosis, reduced range of movement, scoliosis, and neurological complications. Conclusion Spondylodiscitis is an uncommon, heterogeneous, multifactorial disease with resulting difficult and delayed diagnosis. Due to its morbidity, it is essential to investigate children with refusal to walk, gait disturbances, or back pain, particularly when associated with elevated inflammatory markers.

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What Do We Know about Spondylodiscitis in Children? A Retrospective Study

Cited by 3 publications

References 20 publications

Early Diagnosis and Successful Empirical Treatment of L1-L2 Spondylodiscitis in a 21-Month-Old Girl: A Case Report

Early Diagnosis and Successful Empirical Treatment of L1-L2 Spondylodiscitis in a 21-Month-Old Girl: A Case Report

The benefit of antibiotic-combined Mg-hydroxyapatite bone graft substitute over autologous bone for surgical site infection prevention in posterolateral spinal fusion: a retrospective cohort study

Understanding the management of pediatric spondylodiscitis based on existing literature; a systematic review

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