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Anterior disc protrusion as a cause for abdominal symptoms in childhood discitis. A case report
J K Wong-Chung1, S A Naseeb, S G Kaneker
1Department of Orthopaedic Surgery, Salmaniya Medical Center, Bahrain.
Insights
Anterior disc herniation in infectious spondylitis can cause abdominal pain in children. Magnetic resonance imaging (MRI) confirmed this link and showed resolution after treatment.
Area of Science:
- Pediatric infectious diseases
- Spinal imaging and diagnostics
- Musculoskeletal imaging
Background:
- Infectious spondylitis (IS) is typically associated with posterior disc protrusion causing back pain and radiculopathy.
- Anterior disc herniation in IS has not been previously linked to specific clinical symptoms.
Observation:
- A case report details a 6-year-old child presenting with abdominal pain and diagnosed with infectious spondylitis.
- Magnetic resonance imaging (MRI) revealed anterior herniation of disc material and phlegmon at the L5-S1 level.
Findings:
- The anterior disc herniation in infectious spondylitis correlated with the patient's abdominal pain.
- Follow-up MRI at 3 months showed complete resolution of the disc herniation.
Implications:
- This case suggests anterior disc herniation should be considered in the differential diagnosis of abdominal pain in pediatric infectious spondylitis.
- Further research correlating disc herniation direction with symptoms in infectious spondylitis is warranted to refine classification.
Study Design:
A case report on infectious spondylitis in a child who reported abdominal pain and whose magnetic resonance image revealed anterior herniation of disc space contents.
Objectives:
To correlate the direction of disc protrusion in infectious spondylitis with clinical manifestations.
Summary Of Background Data:
Previous studies have correlated posterior protrusion of disc space contents in infectious spondylitis with a clinical presentation of back pain, paravertebral muscle spasm, hamstrings tightness, and radiculopathy. None has connected anterior herniation of disc phlegmon with abdominal pain.
Methods:
In addition to plain radiography and bone scintigraphy, magnetic resonance imaging was used to confirm the diagnosis of infectious spondylitis in a 6-year-old child with abdominal pain. Regular review for 1 year included repeat magnetic resonance imaging at 3 months.
Results:
Initial magnetic resonance imaging revealed characteristic changes associated with infectious spondylitis throughout the L5-S1 vertebra-disc-vertebra unit and anterior protrusion of the disc material and phlegmon. Magnetic resonance imaging at follow-up examination 3 months later demonstrated complete resolution of the disc herniation.
Conclusion:
Future magnetic resonance imaging studies should correlate direction of disc herniation with age and symptomatology to validate or improve classifications of infectious spondylitis, which presently include only the last two parameters.