Menelaus M.B. "Discitis" JBJS 46B: 16-23, 1964. Wenger etal "The spectrum of intervertebral disc space infection in children" JBJS 60A:100-108, 1978
Definition
A benign disease of unknown aetiology, characterised by back pain, disc space narrowing, and resolution of symptoms with rest
Incidence
- Rare
- Average age 3 y/o
Aetiology
Unknown
Clinically
- Pain
- Difficulty walking or sitting
- May be associated with fever, malaise
- May be preceded by URTI
- Reduced motion, muscle spasm, abnormal posture
Investigation
- Bloods
- ESR usually up
- WBC usually normal
- Blood cultures positive in ~ 50%. After 6 weeks of onset of symptoms, organisms could not be isolated from blood cultures, due to rapid destruction of bacteria once the end plates are breached
- Radiology
- Early : normal
- Later : disc narrowing, progressive end plate lesions with erosion into the vertebral body
- Latest : rarely fusion, usually very little residual disc narrowing
- CT
- MRI
Treatment
- Rest until no pain or limitation of motion and until ESR normal
- Antibiotics indicated if
- Febrile
- Positive blood cultures
- Positive biopsy
- IV until patient comfortable, then oral for 3 more weeks
Prognosis
Good, spontaneous recovery is almost the rule