Abstract
In children, infectious discitis (D) and infectious spondylodiscitis (SD) are rare diseases that can cause significant clinical problems, including spinal deformities and segmental instabilities. Moreover, when the infection spreads into the spinal channel, D and SD can cause devastating neurologic complications. Early diagnosis and treatment may reduce these risks. The main aim of this paper is to discuss recent concepts regarding the epidemiology, microbiology, clinical presentation, diagnosis, and treatment of pediatric D and SD. It is highlighted that particular attention must be paid to the identification of the causative infectious agent and its sensitivity to antibiotics, remembering that traditional culture frequently leads to negative results and modern molecular methods can significantly increase the detection rate. Several different bacterial pathogens can cause D and SD, and, in some cases, particularly those due to Staphylococcus aureus, Kingella kingae, Mycobacterium tuberculosis, Brucella spp., the appropriate choice of drug is critical to achieve cure.
Highlights
In children, infectious discitis (D), i.e., infection of the vertebral disc, and infectious spondylodiscitis (SD), i.e., the simultaneous infection of a vertebral disc and the adjacent vertebral bodies, are rare diseases that can cause significant clinical problems [1,2,3,4,5,6,7]
A more recent evaluation carried out in a French pediatric orthopedic unit where more modern methods for diagnosis were in use has estimated that D and SD together accounted for approximately 3% of all the cases of osteoarticular infections (OAIs) admitted to the unit [11]
Pyogenic bacteria are usually detected, with Staphylococcus aureus being the cause of D and SD in approximately 80% of the cases that occur in the first months of life and in most of those that develop in older children [1,2,3,4,5,6,7]
Summary
Infectious discitis (D), i.e., infection of the vertebral disc, and infectious spondylodiscitis (SD), i.e., the simultaneous infection of a vertebral disc and the adjacent vertebral bodies, are rare diseases that can cause significant clinical problems [1,2,3,4,5,6,7]. D and SD are usually divided into pyogenic (i.e., the most frequent); unspecific granulomatous; specific (such as tuberculosis); and parasitic. Pyogenic SD is the most frequent form and other presentations are exceptional. When the infection spreads into the spinal channel, D and SD can cause devastating neurologic complications. These severe complications are quite common in non-pyogenic infections, including cases due to Mycobacterium tuberculosis that are endemic in some developing and emerging countries but are diagnosed in the industrialized world. Diagnosis and treatment might reduce these risks. Clinicians caring for children must be especially well versed in these concepts as they can be used to guide evaluation and treatment, thereby reducing the risk of major spinal complications following these diseases The literature search was performed using PubMed and considered all of the papers published in the English language since 1 January 2010, using the key words: “discitis” or “spondylodiscitis” and “children” or ”pediatrics” or “pediatric age.” Clinicians caring for children must be especially well versed in these concepts as they can be used to guide evaluation and treatment, thereby reducing the risk of major spinal complications following these diseases
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