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Childhood Diskitis

Dr. Early is Assistant Professor, Division of Orthopaedic Surgery, Childrens Hospital Los Angeles and University of Southern California–Keck School of Medicine, Los Angeles, CA. Dr. Kay is Assistant Professor, Division of Orthopaedic Surgery, Childrens Hospital Los Angeles and University of Southern California–Keck School of Medicine. Dr. Tolo is Professor and John C. Wilson Chair of Orthopaedic Surgery, Childrens Hospital Los Angeles and University of Southern California–Keck School of Medicine.

Childhood diskitis may occur in the thoracic, lumbar, or sacral spine and can affect children of all ages, but it is most common in the lumbar region in children younger than 5 years. Physical examination, laboratory tests, and radiologic studies all aid in the diagnosis of this clinical syndrome, and proper use can prevent unnecessary invasive intervention. Presentation varies with age; the child may refuse to bear weight on the lower extremities or may present with back pain, abdominal pain, a limp, or, if an infant or toddler, with irritability. The etiology appears to be a bacterial infection, usually caused by Staphylococcus aureus. Most children improve rapidly with a 4- to 6-week course of antibiotics. Although not routinely necessary, immobilization decreases symptoms and, in the case of osseous destruction, prevents progression of spinal deformity. Biopsy of the infected disk space is reserved for children refractory to intravenous antibiotics. Follow-up should include plain radiographs at regular intervals for 12 to 18 months to ensure resolution of the destructive process.

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