The peculiarities and treatment outcomes of the spinal form of chronic non-bacterial osteomyelitis in children: a retrospective cohort study

Chronic Nonbacterial Osteomyelitis in Children

“…Osteomyelitis of the sternum, clavicle, or jaw is suggestive of CNO [ 6 ], whereas the skull is almost never affected [ 18 , 19 ]. Spinal involvement is seen in up to a third of cases (20–46%) [ 10 , 20 ] and it is an important prognostic factor, since it can be complicated by vertebral fracture [ 20 ]. When multifocal, lesions are asymmetric in approximately 60% of cases [ 6 , 15 ].…”

“…The percentage of patients presenting with systemic inflammation at CNO onset varies significantly. In particular, the proportion of increased inflammatory markers reported, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), ranges between 19 and 90% in different studies [ 4 , 6 , 7 , 8 , 9 , 10 , 14 , 15 , 17 , 19 , 20 , 21 , 22 , 23 ]. It is interesting to note that ESR and CRP levels do not seem to be predictive of a particular course of the disease [ 4 , 5 ].…”

“…It is suggested that it should be maintained for at least one month before evaluating the response [ 19 ]. Many retrospective studies have shown that NSAIDs produce a clinical improvement and can achieve control of the symptoms or clinical remission in more than 50% of all patients within the first 12 months [ 6 , 8 , 20 , 22 , 23 , 25 , 65 ]. Beck et al confirmed the previously described results in a prospective study, showing significant clinical improvement in the first year of treatment in 43% of the patients, and a decrease in the number of radiological bone lesions in the first three months [ 5 ].…”

The Many Faces of Pediatric Chronic Recurrent Multifocal Osteomyelitis (CRMO): A Practical Location‐ and Case‐Based Approach to Differentiate CRMO From Its Mimics

“…30 Some authors have described phenotypic patterns of disease, such as multifocal, peripheral, or tibio-appendicular disease, vs. pauci-focal, spinal, or claviculo-spinal disease patterns based on findings from WB-MRI. 29,31,32 While the clinical implication of these phenotypic categories is not yet clear, such patterns may be useful for the radiologist when considering a differential diagnosis in a setting where CRMO is a consideration, but not confirmed.…”

“…Case 1: 11-year-old girl presents with 6 months of shoulder pain after injury. Involvement of the clavicle has been reported to occur in up to 38% of CRMO patients, 6,29,31,33 and is considered a CRMO-suggestive location, most often involving the medial clavicle (Fig. 1).…”