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Pyogenic infectious spondylitis in children. The evolution to current thought
1Department of Orthopedics, Children's Hospital-San Diego, California, USA.
Insights
Pyogenic infectious spondylitis, including childhood discitis, has evolved in understanding. Current evidence supports treating it similarly in children and adults with antibiotics and immobilization.
Area of Science:
- Medical microbiology
- Pediatric infectious diseases
- Spinal surgery
Background:
- Pyogenic infectious spondylitis understanding has changed with medical advancements.
- New concepts challenge traditional beliefs on the causes and treatment of childhood discitis.
- Historical analysis is crucial for clarifying current controversies.
Purpose of the Study:
- To review the historical evolution of pyogenic infectious spondylitis.
- To clarify controversies regarding childhood discitis (pyogenic infectious spondylitis in children).
- To delineate the limitations of current knowledge.
Main Methods:
- Historical review of pyogenic infectious spondylitis.
- Analysis of medical innovations and their impact on understanding the illness.
- Comparison of pyogenic infectious spondylitis in children and adults.
Main Results:
- The perception and evaluation of illness influence understanding.
- Medical innovations have challenged traditional views on etiology and treatment.
- Similarities exist between pyogenic infectious spondylitis in children and adults.
Conclusions:
- Pyogenic infectious spondylitis in children (discitis) shares similarities with the adult form.
- Treatment should involve parenteral antibiotics for all ages.
- Immobilization and, rarely, operative débridement are indicated for symptomatic relief.
Abstract:
The historic evolution of pyogenic infectious spondylitis from its initial descriptions to its current characterization illustrates the degree to which our means of perception and evaluation influence our understanding of an illness. As new concepts resulting from medical innovations challenge traditional beliefs regarding the etiology and optimum treatment of pyogenic infectious spondylitis in children (commonly termed discitis), controversies have arisen. This review attempts to clarify these issues by reconstructing their historic basis and delineating the limitations of our current knowledge. In our opinion, this exercise demonstrates the similarities between pyogenic infectious spondylitis in children and adults and provides support for the management of this illness at all ages with parenteral antibiotics, cast or brace immobilization when needed for symptomatic relief, and, rarely, operative débridement.