Paediatric Discitis

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 & refusal to sit or stand
  • Abdominal pain
  • Back pain

Examination

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

Investigation

Paediatric Discitis, mri of discitis
MRI of discitis. Image by Hospital for Sick Children, Toronto, Wikimedia Commons, CC BY-SA 3.0.
  • Bloods
    • ESR usually up
    • WCC usually normal
    • Blood cultures
      • +ve in ~ 50%
        • after 6 weeks of onset of symptoms organisms do not appear to be isolated from blood cultures
        • due to rapid destruction of bacteria once the end plates are breached
  • X-ray
    • 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

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.