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Diagnosis and Surgical Treatment of Human Brucellar Spondylodiscitis
Published on: May 23, 2021
Understanding the management of pediatric spondylodiscitis based on existing literature; a systematic review
Narges Lashkarbolouk1,2, Mahdi Mazandarani1,2, Brice Ilharreborde3
1Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Pediatric spondylodiscitis (SD) presents diagnostic challenges due to vague symptoms. Early investigation of walking refusal, gait issues, or back pain with elevated inflammatory markers is crucial for timely diagnosis and management of this rare condition.
Area of Science:
- Pediatric infectious diseases
- Pediatric rheumatology
- Pediatric orthopedics
Background:
- Spondylodiscitis (SD) in children is rare and difficult to diagnose due to non-specific symptoms and challenges in assessing pain in non-verbal patients.
- The condition's rarity and non-specific presentation contribute to diagnostic delays, impacting patient outcomes.
Approach:
- A systematic literature review was conducted across PubMed/Medline, Web of Science, and Scopus databases until March 2023.
- Inclusion criteria focused on studies detailing clinical characteristics, treatment, and complications of pediatric spondylodiscitis.
- Data extraction and quality assessment were performed independently by two researchers.
Key Points:
- Common symptoms include back pain, fever, and gait disturbances, with an average diagnostic delay of 4.8 weeks.
- The lumbar spine is the most frequently affected site, with Staphylococcus Aureus and Kingella kingae being common pathogens.
- Elevated inflammatory markers (WBC, CRP, ESR) are reported in 94% of cases; radiographic findings include disk narrowing and vertebral destruction.
Conclusions:
- Spondylodiscitis in children is a complex condition with delayed diagnosis due to its heterogeneous nature and multifactorial presentation.
- Prompt evaluation of children with refusal to walk, gait disturbances, or back pain, especially with elevated inflammatory markers, is essential.
- Prompt diagnosis and management are vital due to the potential for significant morbidity, including vertebral destruction and neurological complications.
Background:
Spondylodiscitis (SD), a rare disease in children, poses diagnostic challenges due to non-specific presenting symptoms, scarcity in incidence, and difficulty expressing pain in non-verbal children.
Method:
A comprehensive search was conducted on three databases, including PubMed/Medline, Web of Science, and Scopus until March 2023. The inclusion criteria were studies that investigated the clinical characteristics, treatment, and complications of children's spondylodiscitis. Full text of cross-sectional and cohort studies were added. The quality assessment of cohort studies was conducted using the Newcastle-Ottawa Quality Assessment Scale. The search, screening, and data extraction were performed by two researchers independently.
Result:
Clinical manifestations of discitis in children are nonspecific, such as back pain, fever, reduced ability or inability to walk or sit, limping, and reduced range of movements. The mean delay in the time of diagnosis was 4.8 weeks. The most affected site of all the studies was the lumbar spine. 94% of studies reported increased inflammatory markers such as white blood cell count, C-reactive protein, and erythrocyte sedimentation rate. Less than 30% of patients had positive blood cultures and biopsy findings. The most common microbiological results (64%) were Staphylococcus Aureus and Kingella kingae. In radiographic evaluation, intervertebral disk narrowing, lumbar lordosis reduction, loss of disk height, and destruction of the vertebral body have been reported. In all studies, antibiotic therapy was initiated; in 52% immobilization was employed, and 29% of studies reported surgery was performed, and the follow-up period differed from 1.5 months to 156 months. 94% of studies reported complications such as vertebral body destruction, back pain, kyphosis, reduced range of movement, scoliosis, and neurological complications.
Conclusion:
Spondylodiscitis is an uncommon, heterogeneous, multifactorial disease with resulting difficult and delayed diagnosis. Due to its morbidity, it is essential to investigate children with refusal to walk, gait disturbances, or back pain, particularly when associated with elevated inflammatory markers.
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