Paediatric Disciitis

Definition

a benign disease of unknown aetiology characterised by
- back pain
- disc space narrowing
- resolution of symptoms with rest

Incidence

rare
average age 3 yo

Aetiology

unknown
- ? Is it infective
- ? Is it non-infective

History

Younger children
Gradual onset of 2-4 weeks
may be preceded by URTI etc
Irritable, limping & refusual to sit or stand
Abdominal pain
Back pain

Examination

Fever > 50%
Look
- Decreased lumbar lordosis
Feel
- Lumbar tenderness
Move
- Hip irratable in extension – psoas stretch
- Positive SLR
- Positive ↓ in popliteal angles secondary to hamstring spasm
- Paravertebral muscle spasm

Investigation

Bloods
- ESR usually up
- WCC usually normal
- Blood cultures
  - +ve in ~ 50%
    - after 6 weeks of onset of symptoms organisms do not appear to isolated from blood cultures
    - due to rapid destruction of bacteria once the end plates are breached
Xray
- early
  - normal
- later
  - disc narrowing
  - progressive end plate lesions with erosion into the vertebral body
- latest
  - fusion rare, usually very little residual disc narrowing
Bonescan
- 72% positive
CT
- show the bony detail
MRI
- if neurologic concerns

Treatment

Rest
- until no pain or limitation of motion, & until ESR normal
Antibiotics
- indicated if febrile
- +ve blood cultures
- +ve biopsy
- IV until patient comfortable, then oral for 3 more weeks

Prognosis

good- spontaneous recovery is almost the rule