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Diagnosis and Surgical Treatment of Human Brucellar Spondylodiscitis
Published on: May 23, 2021
Spondylodiscitis in children: a retrospective series
J Chandrasenan1, Z Klezl, R Bommireddy
1Department of Trauma and Orthopaedics, Spinal Unit, Uttoxeter Road, Derby DE22 3NE, UK. j_chandrasenan@yahoo.co.uk
Insights
Pediatric spondylodiscitis often presents with vague symptoms, leading to diagnostic delays. Early MRI may improve outcomes, though older children may develop long-term degenerative changes.
Area of Science:
- Pediatric Orthopedics
- Pediatric Infectious Diseases
- Pediatric Radiology
Background:
- Spondylodiscitis in children can be challenging to diagnose due to non-specific symptoms.
- Delayed diagnosis may lead to prolonged treatment and potential long-term complications.
Purpose of the Study:
- To review the clinical presentation, diagnostic methods, and treatment outcomes of pediatric spondylodiscitis.
- To evaluate the impact of diagnostic delays and the utility of imaging modalities.
Main Methods:
- Retrospective review of 16 pediatric patients diagnosed with spondylodiscitis between 2000 and 2007.
- Analysis of clinical presentation, diagnostic investigations (including plain radiography and ESR), treatment, and follow-up data.
Main Results:
- A mean diagnostic delay of 25 days was observed in younger children (<24 months).
- Common symptoms included refusal to walk/sit, fever, irritability, and limping; plain radiography was often non-diagnostic.
- Erythrocyte Sedimentation Rate (ESR) was useful for monitoring disease course; Staphylococcus aureus was the most common pathogen.
- Most children achieved clinical recovery, but older children (>24 months) showed radiological degenerative changes.
Conclusions:
- Pediatric spondylodiscitis frequently presents with a confusing clinical picture, resulting in delayed diagnosis.
- Early Magnetic Resonance Imaging (MRI) is recommended for children with atypical presentations to expedite treatment.
- While clinical recovery is common, long-term radiological consequences may occur, particularly in older children.
Abstract:
We retrospectively reviewed the records of 16 children treated for spondylodiscitis at our hospital between 2000 and 2007. The mean follow-up was 24 months (12 to 38). There was a mean delay in diagnosis in hospital of 25 days in the ten children aged less than 24 months. At presentation only five of the 16 children presented with localising signs and symptoms. Common presenting symptoms were a refusal to walk or sit in nine children, unexplained fever in six, irritability in five, and limping in four. Plain radiography showed changes in only seven children. The ESR was the most useful investigation when following the clinical course of the disease. Positive blood cultures were obtained in seven children with Staphylococcus aureus being isolated in five. Antibiotics were used in 14 children and spinal bracing in six. Children with spondylodiscitis often present with a confusing clinical picture leading to late diagnosis. The early use of MRI in the investigation of children with an atypical picture may avoid unnecessary delay in starting treatment and possibly prevent long-term problems. All except one of our children had made a complete clinical recovery at final follow-up. However, all six children in the > 24-month age group showed radiological evidence of degenerative changes which might cause problems in the future.
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