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Published on: May 23, 2021
What Do We Know about Spondylodiscitis in Children? A Retrospective Study
Ayla Yagdiran1, Charlotte Meyer-Schwickerath2, Raphael Wolpers1
1Department of Orthopedic and Trauma Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany.
Insights
Pediatric spondylodiscitis (PSD) presents diagnostic challenges due to nonspecific symptoms in infants. Conservative treatment is often effective, but specific guidelines for pediatric cases are needed.
Area of Science:
- Pediatric Infectious Diseases
- Spinal Infections
- Musculoskeletal Disorders
Background:
- Pediatric spondylodiscitis (PSD) is a rare condition impacting children's mobility.
- Limited data exists on PSD's demographics, microbiology, clinical course, and outcomes.
- Comparing PSD with adult spondylodiscitis (ASD) can reveal unique aspects.
Purpose of the Study:
- To present clinical experiences with PSD at a tertiary hospital from 2009-2019.
- To compare the characteristics and management of PSD with ASD.
- To highlight diagnostic and therapeutic challenges in pediatric cases.
Main Methods:
- Retrospective analysis of 10 pediatric spondylodiscitis cases.
- Comparison of clinical data between pediatric and adult spondylodiscitis cohorts.
- Review of diagnostic methods, causative agents, and treatment outcomes.
Main Results:
- Most pediatric patients presented with nonspecific pain (e.g., hip pain, limping), delaying diagnosis.
- Eight of ten PSD cases were managed conservatively; two required surgery (one tuberculous).
- Causative agents were identified in only three patients; diagnosis was often difficult.
Conclusions:
- Nonspecific symptoms and undetected pathogens complicate PSD diagnosis.
- Empirical anti-infective therapy appears effective, with a recommendation for shorter durations in children.
- Further studies are needed to identify predisposing factors for PSD, and specific guidelines are desirable.
Abstract:
Pediatric spondylodiscitis (PSD) is a rare disease with a major impact on mobility and functional status. Data concerning demographic and microbiological characteristics, clinical course, treatment, and outcome are scarce. Therefore, the aim of this study was to present clinical experiences of a third-level hospital (2009-2019) in PSD and compare these with adult spondylodiscitis (ASD). Of a total of 10 PSD patients, most of the infants presented with unspecific pain such as hip pain or a limping, misleading an adequate diagnosis of spine origin. Eight patients could be treated conservatively whereas surgery was performed in two cases with one case of tuberculous PSD (tPSD). The causative agent was detected in three of the patients. The diagnosis of PSD is often difficult since clinical symptoms are unspecific and causative pathogens often remain undetected. Nevertheless, empirical anti-infective therapy also seems to be effective. Based on recent studies, clinicians should be encouraged to keep the duration of anti-infective therapy in children short. Since comorbidities are not presented in PSD it is unclear which children suffer from PSD; thus, studies are necessary to identify predisposing factors for PSD. In our study, PSD differs from ASD in diagnostic and especially in therapeutic aspects. Therefore, specific guidelines for PSD would be desirable.
