Paediatric spondylodiscitis: a 10-year single institution experience in management and clinical outcomes

The Diagnosis and Management of Pediatric Spine Infections

“…The presence of pure discitis in children has been extensively debated among researchers, but the current available evidence indicates that the nucleus pulposus is avascular in both children and adults, and the cartilage endplate and annulus fibrosus receive variable blood supply though life. Pyogenic spondylitis in both age groups is a process that starts in the vertebral endplate [ 4 ]. Some similarities and differences of spondylodiscitis in adults and children are summarized in Table 1 [ 2 , 6 ].…”

“…The usual route of spinal infection in the pediatric population is through a transient minor hematogenous bacteremia [ 4 ]. It can also be due to direct inoculation from a diagnostic or surgical procedure, following trauma or direct inoculation from an adjacent genitourinary, gastrointestinal, or oropharyngeal infection [ 5 , 7 ].…”

“…Erythrocyte sedimentation rate was found to be more sensitive than C-reactive protein in aiding with the diagnosis in one cohort (78% versus 38%) [ 4 ].…”

“…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 ]. The mean age at presentation is 4.3 years (range is from one to 15 years), and the female to male ratio is 1.3:1 [ 4 ].…”

“…Several factors pertaining to the pediatric population can make the diagnosis and treatment more challenging; these include difficulty obtaining a history in non-verbal children, low sensitivity of blood cultures, CT-guided biopsy, non-specific findings of imaging studies in the early stages of the disease, and the lack of consensus on the best treatment approach [ 4 , 5 ].…”