Contiguous discitis and osteomyelitis in children

Area of Science:

• Pediatric Radiology
• Spinal Infections
• Musculoskeletal Imaging

Background:

• Contiguous discitis and osteomyelitis are serious spinal infections.
• Accurate diagnosis and assessment of extent are crucial for management.
• Understanding the long-term sequelae is important for patient outcomes.

Purpose of the Study:

• To evaluate the utility of magnetic resonance imaging (MRI) in diagnosing contiguous discitis and osteomyelitis.
• To define the anatomic extent of vertebral and soft-tissue involvement.
• To assess the long-term sequelae of these infections in pediatric patients.

Main Methods:

• Retrospective review of 16 patients with contiguous discitis and osteomyelitis.
• Detailed analysis of MRI findings, including signal changes in discs, vertebrae, and soft tissues.
• Serial roentgenogram comparison for assessing changes in disc-space height and vertebral foramina.
• Histologic examination of vascular anatomy in immature vertebrae.

Main Results:

• MRI provided specific diagnoses and delineated the extent of infection in all patients.
• Common MRI findings included altered signal in discs, adjacent vertebrae, and prevertebral tissues.
• Long-term follow-up revealed significant disc-space height reduction (mean 43%), loss of lumbar lordosis, and progressive vertebral fusion in some cases.
• Narrowing of vertebral foramina was observed in 7 patients.

Conclusions:

• MRI is a valuable tool for diagnosing contiguous discitis and osteomyelitis and assessing its extent.
• These infections can lead to significant long-term spinal deformities and complications.
• Understanding the vascular anatomy of immature vertebrae aids in explaining disease characteristics.