Updated: 3/10/2020

Disk Space Infection - Pediatric

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Review Topic
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https://upload.orthobullets.com/topic/2028/images/lateralxrdiskitis.jpg
https://upload.orthobullets.com/topic/2028/images/pediatric diskitis t2 mri.jpg
Introduction
  • Most commonly seen in pediatric population
    • usually in patients < 5 years of age
    • more common in males
    • most common in lumbar spine (50-60%)
  • Organism
    • staph aureus is most common causative organism (>80%)
    • gram negative organism are seen in older children
    • always consider tuberculosis
  • Pathogenesis
    • in children vascularity extends through the cartilagenous growth plate and into the nucleus pulposus which allows direct inoculation of the disc
      • infection spreads from end plate to disc space and may then spread to vertebral body
    • in adults the vascularity ends in the annulus
      • this is why it is uncommon to see isolated discitis in adults as you see in children
Presentation
  • Symptoms depends on age of child
    • toddler
      • refusal to sit or walk
      • abdominal pain
      • fever (may be afebrile)
      • loss of appetite
    • older children
      • back pain with point tenderness
  • Physical exam
    • tender to palpation over involved level
    • limited motion
Labs
  • Serum Labs
    • ESR
      • high normal or mildly elevated
    • C-reactive protein
      • high normal or mildly elevated
    • WBC
      • high normal or mildly elevated
  • Blood Cultures
    • blood cultures should be obtained to identify organism
Imaging
  • Radiographs
    • radiographic findings are unreliable
    • earliest manifestation is at 1 week
    • findings
      • usually normal radiographs early in process
      • loss of lumbar lordosis may be earliest radiographic sign 
      • disc space narrowing (10-21 days after infection begins) 
      • endplate erosion (10-21 days after infection begins)
  • MRI
    • diagnostic test of choice 
Treatment
  • Nonoperative
    • bedrest, immobilization, and antibiotics for 4-6 weeks
      • indications
        • early infection with no abscess or displacement of thecal sac
      • technique
        • initial treatment is with antibiotics directed at staph aureus (most likely organism-80%)
      • followup
        • watch serial labs to monitor efficacy of antibioitc treatment
        • obtain CT-guided biopsy if no response (rule out TB)
  • Operative
    • surgical debridement followed by antibiotic treatment
      • indications
        • late infection 
        • abscess present
        • neurologic deficits
      • technique
        • followed with antibiotics and bracing
 

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(OBQ06.21) In pediatric discitis, which of the following is the most accurate description of the radiographic findings. Review Topic | Tested Concept

QID: 32
1

The earliest radiographic finding is loss of normal lumbar lordosis, followed by disc space narrowing and endplate erosion.

65%

(2296/3540)

2

The earliest radiographic finding is disc space narrowing, followed by endplate erosion and loss or normal lumbar lordosis.

16%

(574/3540)

3

The earliest radiographic finding is endplate erosion, followed by disc space narrowing and loss or normal lumbar lordosis.

8%

(267/3540)

4

The earliest radiographic finding is scalloping of the inferior endplate, followed by disc space narrowing and endplate erosion.

9%

(318/3540)

5

The earliest radiographic finding is vertebra magna, followed by disc space narrowing and endplate erosion.

2%

(69/3540)

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