The aetiology of juvenile spondylarthritis (discitis)

Abstract

The condition known as juvenile discitis has hitherto been regarded as a spinal infection. The cases (120) in the English literature are reviewed and the evidence of infection is compared with that found in experimental disc infection, in adult infective spondylitis and in acute osteomyelitis. In every respect the evidence of infection in discitis is found to be deficient. Discitis is shown to have, in addition, anomalies of age and site distribution and sex ratio which are inexplicable on an infective basis. The hypothesis is advanced that while occasional cases of ‘discitis’ are due to infection, the vast majority are due to partial dislocation of the epiphysis during the vulnerable phase prior to the development of protective metaphyseal rippling. It is pointed out that this hypothesis explains the age and site distribution, the sex ratio, the x-ray appearances and the benign clinical course of the condition. The condition known as juvenile discitis has hitherto been regarded as a spinal infection. The cases (120) in the English literature are reviewed and the evidence of infection is compared with that found in experimental disc infection, in adult infective spondylitis and in acute osteomyelitis. In every respect the evidence of infection in discitis is found to be deficient. Discitis is shown to have, in addition, anomalies of age and site distribution and sex ratio which are inexplicable on an infective basis. The hypothesis is advanced that while occasional cases of ‘discitis’ are due to infection, the vast majority are due to partial dislocation of the epiphysis during the vulnerable phase prior to the development of protective metaphyseal rippling. It is pointed out that this hypothesis explains the age and site distribution, the sex ratio, the x-ray appearances and the benign clinical course of the condition.