summary Disc space infections in the pediatric population are a common source of fever and low back pain and are caused by systemic infections Diagnosis is made with blood cultures and MRI Treatment includes bed rest, immobilization, and antibiotics for 4-6 weeks for early infection without abscess. Surgical debridement followed by antibiotic treatment is indicated in the presence of an abscess and/or lack of improvement with nonoperative treatment Epidemiology Demographics more common in pediatric patients compared with adults more common in males usually affects patients <5 y/o Anatomic location most commonly occurs in the lumbar spine (50-60%) Etiology Pathophysiology pathoanatomy in children, blood vessels extend from the cartilaginous endplate into the nucleus pulposus login to view 2 more bullets in adults, blood vessels extend only to the annulus fibrosus login to view 1 more bullet microbiology Staphylococcus aureus login to view 1 more bullet tuberculosis login to view 1 more bullet Salmonella login to view 1 more bullet Anatomy Disc anatomy in children, blood vessels extend from the cartilaginous endplate into the nucleus pulposus in adults, blood vessels extend only to the annulus fibrosus Presentation Symptoms depend on the age of the child toddlers painful limping or refusal to sit or walk loss of appetite fever (present in only 25%) abdominal pain older children back pain with point tenderness Physical exam tender to palpation over the involved level limited range of motion Imaging Radiographs radiographic findings are unreliable earliest radiographic manifestation occurs at 1 week findings usually normal radiographs early in the process loss of lumbar lordosis may be the earliest radiographic sign disc space narrowing (10-21 days after infection onset) endplate erosion (10-21 days after infection onset) MRI diagnostic test of choice Studies Serum labs ESR high-normal or mildly elevated C-reactive protein high-normal or mildly elevated WBC high-normal or mildly elevated Blood cultures to identify the organism Treatment Nonoperative bed rest, immobilization, and antibiotics for 4-6 weeks indications login to view 1 more bullet modalities login to view 1 more bullet follow-up login to view 4 more bullets Operative surgical debridement followed by antibiotic therapy indications login to view 3 more bullets technique login to view 2 more bullets Complications Long-term narrowing of the disc space Fusion between vertebrae Back pain