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[Discitis in children less than 3 years old: a case series and literature review]
I Miranda1, M Salom1, S Burguet1
1Unidad de Ortopedia Infantil, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario y Politécnico La Fe, Valencia, España.
Insights
Diagnosing discitis in children under three is challenging due to non-specific symptoms. Magnetic resonance imaging (MRI) is crucial for diagnosis, with treatment involving antibiotics and immobilization, though radiographic abnormalities may persist.
Area of Science:
- Pediatric Infectious Diseases
- Pediatric Orthopedics
- Diagnostic Imaging
Context:
- Discitis in children under three years old presents diagnostic challenges.
- Early symptoms are often non-specific, leading to delayed diagnosis and misdiagnosis.
Purpose:
- To review cases of discitis in children under three years old treated at our unit.
- To evaluate diagnostic methods and treatment outcomes for pediatric discitis.
Summary:
- A retrospective review of 10 pediatric discitis cases (under 3 years) identified L5-S1 as the most affected spinal level.
- Delayed diagnosis averaged 3.7 weeks, with common symptoms including refusal to sit/walk and spinal pain. Magnetic resonance imaging (MRI) proved diagnostic in all evaluated patients.
- Treatment with antibiotics and orthosis led to asymptomatic outcomes, though 80% showed persistent radiographic abnormalities.
Impact:
- Highlights the difficulty in diagnosing discitis in young children.
- Emphasizes the critical role of MRI in accurate diagnosis.
- Suggests long-term follow-up is necessary due to persistent radiographic findings.
Objective:
Review of the cases of discitis treated in our unit in children under 3 years old.
Material And Method:
A retrospective medical record review was made of 10 cases with a diagnosis of discitis at discharge, in children hospitalized from January 1998 to December 2010.
Results:
The most affected level was L5-S1 (4 cases), followed by L4-L5 (3 cases). The history at presentation was non-specific and caused a delay in the diagnosis of 3.7 weeks, and a wrong initial diagnosis in 7 patients. Most frequent symptoms were the refusal to sit (70%) and an alteration in gait or refusal to walk (50%), with pain at spinal palpation (80%), and stiffness (70%). All patients had unspecific laboratory test anomalies, and radiographs were normal in 6 patients. Magnetic resonance imaging (MRI) was performed on 9 patients and was diagnostic in all of them. All patients were treated and remain asymptomatic after a mean follow-up of 24.2 months, but radiographic abnormalities persist in 80% of them.
Discussion:
The diagnosis of discitis is difficult in patients under 3 years due to the absence of specific clinical and laboratory findings. Magnetic resonance is the tool of choice to make the diagnosis. Treatment consists of a combination of antibiotics and orthosis. Radiological abnormalities persist in the majority of cases.
Conclusions:
In patients under 3 years with the suspected diagnosis of discitis, MRI should be considered in the diagnosis of discitis. Symptoms resolve with antibiotics and immobilization. Because of the persistency of the radiographical abnormalities, a long-term period of follow-up is advised to detect long-term sequelae.
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