Review Question - QID 32

Childhood discitis is a continuum of spinal infections ranging from discitis to vertebral osteomyelitis with soft tissue abscesses. Loss of normal lordosis is the first radiographic sign and is often present before any bony changes can be seen.

Additional radiographic findings are related to the duration of infection. Isolated disk space narrowing may be seen after 1 week. Endplate changes may be seen at 1-3 weeks. “Sawtooth” erosion of adjacent vertebral end plates may be seen at 3-4 weeks. Scalloping of the superior or inferior endplates may be seen with longstanding infections. Vertebra magna with resulting canal narrowing, permanent loss of disc height, or block vertebra caused by spontaneous disc space fusion may be noted in patients with resolved infections.

The reference by Early et al. emphasize that physical examination, laboratory tests, and radiologic studies all aid in the diagnosis of this clinical syndrome. They report "most children improve rapidly with a 4- to 6-week course of antibiotics. Biopsy of the infected disk space is reserved for children refractory to intravenous antibiotics."

The reference by Szalay et al. is a case series of four patients that investigates the role of magnetic resonance imaging in the diagnosis of acute discitis in children. They found MRI to be more effective than radionuclide scans to diagnose diskitis in children, and argue its use might prevent delays in diagnosis.

Illustration A, B, and C come from the Early et al reference, and show the radiographic appearance of pediatric discitis at 2 weeks, 4 weeks, and 2.5 years respectively.