Abstract
Spondylodiscitis (SD) is the concurrent infection of the intervertebral disc and the adjacent vertebral bodies. Currently, there is a substantial lack of structured reviews about this topic. The aim of this study was to systematically review the available literature in order to determine the main features of pediatric SD. A systematic search of MEDLINE database was performed, according to the PRISMA guideline recommendations. Clinical features, laboratory data, radiological signs, treatments strategies, and outcomes were summarized. Studies’ quality assessments were performed using the JBI Critical Appraisal Checklists. A total of 35 retrospective studies were analyzed and 340 children were identified. The most frequently affected age class was 0.5–4 years. The most affected site was the lumbar spine. The most commonly reported symptoms were back pain (37.97%) and refusal to walk/to stand/to sit (49.79%). The most frequently identified pathogen was Staphylococcus aureus (n = 33). The most used antibiotics were third generation cephalosporins. The intravenous therapy duration range was 1–25 weeks, the oral therapy duration range was 5 days–36 months. Surgery was used in 5.88% of children. In 29 cases clinical sequelae were documented. This study provides the main features of pediatric SD; it also emphasizes the significant gaps in the literature regarding this topic.
Highlights
Spondylodiscitis (SD) is a term frequently used to describe a continuum of spinal infections, from discitis to vertebral osteomyelitis through SD, with occasional associated soft-tissue abscess [1,2,3]
The infection is restricted to the intervertebral disc space, which may lead to disc erosion, whereas in vertebral osteomyelitis the adjacent endplates are affected
The retrieved studies reported that in most cases SD derived from hematogenous spread, except for three case reports (0.88%), in which SD probably derived from infections of contiguous tissues or direct external inoculation from a diagnostic/therapeutic procedure
Summary
Spondylodiscitis (SD) is a term frequently used to describe a continuum of spinal infections, from discitis to vertebral osteomyelitis through SD, with occasional associated soft-tissue abscess [1,2,3]. The term SD covers vertebral osteomyelitis and discitis. Discitis and vertebral osteomyelitis were considered two different entities [4]. The infection is restricted to the intervertebral disc space, which may lead to disc erosion, whereas in vertebral osteomyelitis the adjacent endplates are affected. In more recent studies, children rarely presented with pure discitis. Experts agree that they are two aspects of the same spectrum, which appear in two different stages of the pathological process [5]. The network of arterial anastomoses extends into the intervertebral disc; the infection primarily starts in the disc and spreads to the vertebral endplates
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