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Spondylodiscitis in Pediatric Age: A Retrospective Cohort Study
Stefano Cavalieri1,2, Benedetta Pessina1, Giuseppe Indolfi3,4
1From the Postgraduate School of Pediatrics, University of Florence, Meyer Children's Hospital, Florence.
The Pediatric Infectious Disease Journal
|June 8, 2022
Summary
Pediatric spondylodiscitis symptoms vary by age, with younger children showing subtle signs. Early broad-spectrum antibiotics are key for effective treatment, reserving surgery for complicated cases.
Area of Science:
- Pediatric Infectious Diseases
- Pediatric Orthopedics
- Pediatric Rheumatology
Background:
- Pediatric spondylodiscitis is a rare condition with nonspecific clinical and laboratory findings.
- Diagnosis and treatment are challenging due to difficulties in identifying the cause and a lack of established management guidelines.
Purpose of the Study:
- To investigate age-related differences in the clinical presentation, diagnosis, and management of pediatric spondylodiscitis.
- To describe epidemiologic data, treatment approaches, and follow-up outcomes in children with spondylodiscitis.
Main Methods:
- A retrospective study of 29 children diagnosed with spondylodiscitis.
- Comparison of clinical, hematic, and radiologic data between two age subgroups (under 4 years and 4 years and older).
- Analysis of epidemiologic, management, and follow-up data.
Main Results:
- A slight male predominance and a peak incidence under 2 years were observed.
- Age-specific symptoms: younger children presented with inability to bear weight and irritability, while older children had back pain and fever.
- The lumbar spine was most frequently involved, with a median diagnostic delay of 12 days. Most children received broad-spectrum antibiotics for a median of 12 weeks; surgery was only required in one complicated case.
Conclusions:
- Clinical presentation of pediatric spondylodiscitis is age-dependent, with subtle signs in younger children.
- Prompt initiation of broad-spectrum antibiotics, particularly against Staphylococcus aureus, is crucial for effective treatment and preventing sequelae.
- Surgical intervention should be reserved for complicated cases involving neurologic deficits.
