Discitis in Childhood: 12–35-year Follow-up of 35 Patients

Jansen, B.; Hart, William L.; Schreuder, Oene

doi:10.3109/17453679308994523

Cited by 43 publications

(8 citation statements)

References 7 publications

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“…Paradoxically the subsequent inflammatory response causes damage to the surrounding tissues. In this study, as with childhood discitis, the outcome after inoculation may be the same regardless of the antibiotic treatment [7,14,16]. Treatment of established discitis with antibiotics is rarely successful at preventing endplate destruction [3] and adults (more so than children) are still at risk of developing complications, such as abscess formation, spinal fusion, neurological compromise and recurrent infection [6,9,13].…”

Section: Discussionmentioning

confidence: 90%

Preventing and treating discitis: cephazolin penetration in ovine lumbar intervertebral disc

et al. 2006

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Infection can occur after any spinal procedure that violates the disc and although it is not common, the potential consequences are serious. Treatment of discitis is not always successful and the key to management is prevention. Intradiscal prophylaxis with antibiotic is routinely used in spinal surgery, but there is a limited understanding of how well antibiotics can enter the avascular disc after intravenous injection. An in vivo ovine study to optimise prophylactic and parenteral treatment of discitis is described to assess the effectiveness of cephazolin in preventing and treating infection. The concentration of cephazolin was measured in disc tissue from normal and degenerate sheep discs to determine if cephazolin can enter the disc and if disc degeneration affects antibiotic uptake. Fourteen sheep were deliberately inoculated with bacteria to induce discitis. Eight sheep ("prophylaxis" group) were given either a 0, 1, 2 or 3 g dose of prophylactic cephazolin before inoculation while the remaining sheep ("treatment" group) were treated with cephazolin commencing 7 days after inoculation for 21 days at a dose of 50 mg/kg/day. Histopathology and radiography were used to assess the effect of the different treatments. Cephazolin was given 30 min prior to sacrifice and the intradiscal concentration was measured by biochemistry. In the "prophylaxis" group all doses of antibiotic provided some protection against infection, although it was not dose dependent. In the "treatment" group discitis was confirmed radiologically and histologically in all animals from 2 weeks onwards. Biochemical assay confirmed that antibiotic is distributed throughout the disc but was present in higher concentration in the anulus fibrosus than the nucleus pulposus. This study demonstrated that whilst the incidence of iatrogenic discitis can be reduced by antibiotic prophylaxis, it could not be abolished in all incidences with a broad-spectrum antibiotic such as cephazolin. Furthermore, antibiotics were ineffective at preventing endplate destruction once an intradiscal inoculum was established.

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Section: Discussionmentioning

confidence: 90%

Preventing and treating discitis: cephazolin penetration in ovine lumbar intervertebral disc

et al. 2006

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“…In the growing child, the disk is located between the hyaline cartilage end plates of the adjacent vertebral bodies. These cartilaginous plates contain multiple vascular channels, which are an important source of nutrition for the immature disk, but can also deliver bloodborne bacteria to the disk space in periods of bacteremia [100]. Moreover, the intervertebral disk in children is avascular and, therefore, bacteria may seed here where they are relatively difficult to be reached by immune cells [90].…”

Section: Diskitismentioning

confidence: 99%

Back Pain in Children and Adolescents: Etiology, Clinical Approach and Treatment

Kalligeros¹

2006

CPR

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The purpose of this systematic review is to investigate back pain as a clinical presentation in childhood and adolescence providing the clinician with a comprehensive approach, which will enable for an early recognition of those spinal disorders in need of more aggressive medical intervention. The current literature suggests that young people have a fairly high incidence of non-specific back pain, which seems to be much more frequent than traditionally reported. In schoolchildren, low back pain is mainly associated with psychosocial factors and seems to be mostly benign and selflimiting, therefore, only occasionally requiring medical attention. However, young patients who seek medical assistance, have a higher incidence of organic conditions that can manifest with spinal pain as their predominant symptom. The evaluation of a child or adolescent presenting with back pain can be a challenging task and requires skilled clinical expertise and a high index of suspicion. The physician should have a carefully planned strategy for assessing the pediatric spine patient, which should be accurate, reliable, consistent, and easily reproducible in delineating spinal pathologies. This should include a detailed history, physical examination, radiographic imaging, and appropriate diagnostic laboratory studies. A specific diagnosis will be established in at least 50% of the patients. In certain cases, an exact diagnosis cannot be made, and it is always advisable to re-evaluate the child after a period of initial observation. By then more serious problems will advance and become more obvious while minor symptoms not linked to an underlying pathology will resolve spontaneously.

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“…Long-term outcome (>20 years) is characterized clinically by backache and radiographically by block vertebrae. The use of external fixation orthoses does not appear to influence outcome [9].…”

Section: Discussionmentioning

confidence: 92%

Intervertebral disc space inflammation in children

Maliner

Johnson

1997

Child's Nervous System

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Discitis in children commonly presents with fever, back pain, irritability, and an inability to walk. An elevated ESR and characteristic changes on plain X-rays or bone scan are sufficient for diagnosis, but MRI is more sensitive and more specific, and it shows pathologic changes earlier. Intravenous antibiotics are administered when cultures of the disc space are positive, but in more than half of the cases, no organism can be grown. Symptoms are alleviated with bed-rest or external orthoses, but neither the duration nor the kind of symptomatic treatment influences outcome.

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Discitis in Childhood: 12–35-year Follow-up of 35 Patients

Cited by 43 publications

References 7 publications

Preventing and treating discitis: cephazolin penetration in ovine lumbar intervertebral disc

Preventing and treating discitis: cephazolin penetration in ovine lumbar intervertebral disc

Back Pain in Children and Adolescents: Etiology, Clinical Approach and Treatment

Intervertebral disc space inflammation in children

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