UMEM Educational Pearls

Category: Orthopedics

Title: Pediatric back pain

Keywords: Disc, infection, back pain (PubMed Search)

Posted: 6/22/2019 by Brian Corwell, MD (Updated: 12/7/2019)
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Children are prone to inflammation and infection of the intervertebral discs

-Mean age 3-5years at presentation.

 

Lumbar region frequently involved

 

Although disc biopsy is not necessary for diagnosis, as many as 60% of biopsied discs grow bacteria

-Usually Staphylococcus aureus.

 

Untreated - may spontaneously resolve or progress to vertebral osteomyelitis or abscess

 

Chief complaint: Back pain and irritability, often associated with a limp or refusal to crawl or walk.

Fever is absent or low grade. 

Physical examination findings are nonspecific and may include a tendency to lie still and percussion tenderness over the involved spine.

Blood culture is generally sterile,

WBC count can be normal early in the disease course

 

However, the ESR is elevated in >90% of patients.

 

Plain radiographs are normal at the start of the illness, and generally take 2-3 weeks to demonstrate narrowing of the intervertebral space.

 

Therefore imaging study of choice is MRI.

 

References

Fernandez M, et al. Discitis and vertebral osteomyelitis in children: an 18-year review. Pediatrics 2000.