A toddler who refused to stand or walk: lumbar spondylodiscitis

Heuvel, Rick van den; Hertel, Marc; Gallagher, Julie; Naidoo, Vishal

doi:10.1136/bcr-2012-007007

Cited by 7 publications

(8 citation statements)

References 17 publications

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“…The 7 case reports related to seven different patients . In 5 of the 7 case reports, a specific disease or syndrome was discussed and dipyrone was used as an analgesic.…”

Section: Resultsmentioning

confidence: 99%

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The use of dipyrone (metamizol) as an analgesic in children: What is the evidence? A review

Leeuw

Dirckx

Candel

et al. 2017

Pediatric Anesthesia

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Dipyrone has analgesic, spasmolytic, and antipyretic effects and is used to treat pain. Due to a possible risk of agranulocytosis with the use of dipyrone, it has been banned in a number of countries. The most commonly used data for the use of dipyrone are related to adults. Information relating to the use of dipyrone in children is scarce. Given the potential added value of dipyrone in the treatment of pain, a review of the literature was conducted to obtain more insight into the analgesic efficacy of dipyrone in children as well as the safety of dipyrone in terms of adverse events. A literature search was done for original articles (in English, German, or Spanish language) which met the following criteria: the use of dipyrone for pain and children up to the age of 17 years old. All titles and abstracts retrieved were reviewed, independently, by two of the authors, for their suitability for inclusion. The references of the selected articles were also checked for additional relevant papers. The publications were categorized into case reports, observational studies, or randomized controlled trials. To assess the methodological quality of the studies, the Jadad score was used. In the limited available data, the analgesic efficacy of intravenous dipyrone appears similar to that of intravenous paracetamol. Evidence is lacking to support the claim that dipyrone is equivalent or even superior to Non-Steroid-Anti-Inflammatory-Drugs in pediatric pain. While the absolute risk of agranulocytosis with dipyrone in children, based on available literature, cannot be determined, case reports suggest that this risk is not negligible.

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“…The 7 case reports related to seven different patients . In 5 of the 7 case reports, a specific disease or syndrome was discussed and dipyrone was used as an analgesic.…”

Section: Resultsmentioning

confidence: 99%

“…The 7 case reports related to seven different patients. [29][30][31][32][33][34][35] In 5 of the 7 case reports, a specific disease or syndrome was discussed and dipyrone was used as an analgesic. However, little information relating to the efficacy of dipyrone was provided.…”

Section: Case Reportsmentioning

confidence: 99%

The use of dipyrone (metamizol) as an analgesic in children: What is the evidence? A review

Leeuw

Dirckx

Candel

et al. 2017

Pediatric Anesthesia

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“…Our patient presented with a 3-week history of refusal to walk with frequent episodes of crying, which signify back pain, with no documented history of fever. However, there is a case report of a 19-month-old boy a low-grade fever as his initial presentation, followed by reluctance to stand or walk, with persistent crying and screaming [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Early Diagnosis and Successful Empirical Treatment of L1-L2 Spondylodiscitis in a 21-Month-Old Girl: A Case Report

Janahi,

Ashoor,

Alshaikh

et al. 2024

Am J Case Rep

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Patient: Female, 2-year-old Final Diagnosis: Spondylitis Symptoms: Inability to walk with conistipation Clinical Procedure: Lumbar MRI Specialty: Neurology Objective: Rare disease Background: Infantile spondylodiscitis is a rare condition with a varied clinical presentation. Microbial infection may not always be identified, but early diagnosis and management are required to prevent long-term and irreversible complications, including spinal deformities and vertebral instability. Case Report: This report is of a 21-month-old girl with a 3-week history of difficulty in walking and constipation due to L1-L2 spondylodiscitis following a gluteal skin burn. The family had sought medical advice multiple times, but results of all investigations were unremarkable. Her initial spine X-ray was negative but her spine magnetic resonance imaging (MRI) showed a picture suggestive of spondylodiscitis, which then responded to empiric treatment with broad-spectrum antibiotics. The patient showed complete resolution of clinical symptoms and her bowel habits came back to normal after 6 months of complete antibiotics treatment. Her repeat spine MRI showed a significant improvement of her spondylodiscitis. Conclusions: This report has highlighted the importance of rapid diagnosis and management of infantile spondylodiscitis and the challenging approach to treatment when no infectious organism can be identified, as well as the early initiation of antibiotics therapy when appropriate in pediatric patients to avoid serious neurological complications associated with spondylodiscitis. Thus, it is essential to assess children with refusal to walk, gait problems, or back discomfort, especially when they are associated with high inflammatory markers.

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“…Large field-of-view coronal T1-weighted and fluid-sensitive sequences covering from the pelvis and hips to the ankles may be performed to identify any abnormality. Inclusion of the lower thoracic spine and lumbar spine should be considered if lower extremity or hip pathology is not found and symptoms persist, as some patients with discitis may not have localized symptoms to the back [45][46][47][48]. Once localized, additional MRI sequences with smaller fields of view can be performed for further characterization [49].…”

Section: Radiography Lower Extremitiesmentioning

confidence: 99%

ACR Appropriateness Criteria® Acutely Limping Child Up To Age 5

Safdar

Rigsby

Iyer

et al. 2018

Journal of the American College of Radiology

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Imaging plays in important role in the evaluation of the acutely limping child. The decision-making process about initial imaging must consider the level of suspicion for infection and whether symptoms can be localized. The appropriateness of specific imaging examinations in the acutely limping child to age 5 years is discussed with attention in each clinical scenario to the role of radiography, ultrasound, nuclear medicine, computed tomography, and magnetic resonance imaging. Common causes of limping such as toddler's fracture, septic arthritis, transient synovitis, and osteomyelitis are discussed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

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A toddler who refused to stand or walk: lumbar spondylodiscitis

Cited by 7 publications

References 17 publications

The use of dipyrone (metamizol) as an analgesic in children: What is the evidence? A review

The use of dipyrone (metamizol) as an analgesic in children: What is the evidence? A review

Early Diagnosis and Successful Empirical Treatment of L1-L2 Spondylodiscitis in a 21-Month-Old Girl: A Case Report

ACR Appropriateness Criteria® Acutely Limping Child Up To Age 5

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