Abstract
The management of pediatric spine infections requires a multidisciplinary approach that includes orthopedic surgeons, infectious disease specialists, interventional radiologists, and others.The prevalence of the disease has increased in frequency, virulence, and degree of soft tissue involvement over the past several years; there has also been a resurgence of some types of infections, such as tuberculosis, fungal, and viral pathogens.The diagnosis can often be reached with a detailed history, physical examination, laboratory tests, and imaging studies. Pathologies mimicking infection require a more invasive approach for diagnosis, including core or open biopsy.The treatment of discitis, spondylodiscitis, vertebral osteomyelitis, spinal epidural, and intramedullary abscesses in children is at times complex, and although many infections can be treated non-surgically with antibiotic therapy, some more extensive infections require surgical management.A timely diagnosis is important as it allows the initiation of the appropriate antimicrobial therapy and would decrease the complexity of the subsequent surgical intervention.
Highlights
BackgroundSpinal infection in children includes infection of the spinal cord, the nerve roots, meninges, the vertebra, the intervertebral disc, the epidural, intradural, and intrathecal space, and post-operative infections [1]
The most common organism causing pyogenic infection of the spine in children is methicillin-sensitive Staphylococcus aureus, with Kingella kingae being especially common in patients between six months and four years of age [2,3]
Pediatric spinal infections have a triphasic age distribution; the first is in early infancy, the second is between six months and four years, and the third is in school-aged children [5]
Summary
Spinal infection in children includes infection of the spinal cord, the nerve roots, meninges, the vertebra, the intervertebral disc, the epidural, intradural, and intrathecal space, and post-operative infections [1]. Spondylodiscitis (infection of the disc and vertebral body) was the primary presentation for toddlers, and vertebral osteomyelitis affected older children and adolescent more frequently. They concluded that pure discitis does not occur, and that a pyogenic infection will start at the metaphyseal region of the vertebra and spread to adjacent vertebra and the intervening disc space [2]. Blood cultures in children with pyogenic spine infection are usually negative in the indolent illness presenting with vague back pain and positive in the acute febrile cases, and when they are positive, S. aureus is the most common organism isolated [16,18].
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