Epidemiology
Rare
1:250,000
Etiology
Hematogenous spread either directly to vascularized nucleus in children or via vertebral body
Microbiology
Staphylococcus aureus most common (up to 80%)
Streptococcus, E coli
Kingella kingae - gram negative bacteria in children < 4 years, can have a positive throat swab for K.k.
Atypical - Tuberculosis / Brucella
Clinical presentation
Back pain
Young patients (0 - 2 years) - irritability, unwell, refusal to walk / weight bear / limp
Blood tests often normal - can have elevated WCC / CRP / ESR in more severe cases
Lashkarbolouk et al BMC Pediatr 2023
- systematic review
- mean delay in presentation 5 weeks
X-ray
Lumbar spine > thoracic spine
Xray often normal in first 2 - 3 weeks
- loss of disc height
- end plate irregularity & sclerosis
Severe infections in young patients can destroy vertebrae and cause kyphotic deformity
MRI
Reduced disc height / increased disc signal intensity
Management
Antibiotics
Broad spectrum antibiotics
- cover S. aureus
- consider cover for K kingella if < 4 years old
Results
- 25 patients with spondylodiscitis, mean age 6 years
- most had long delays to treatment due to non specific symptoms
- inflammatory markers usually only mildly elevated
- 48% had evidence of vertebral body destruction