Discitis in young children

Discitis is uncommon in children and presents in different ways at differen t ages. It is most difficult to diagnose in the uncommunicative toddler of one to three years of age. We present 11 consecutive cases. The non-specifi c clinical features included refusal to walk (63%), back pain (27%), inabil ity to flex the lower back (50%) and a loss of lumbar lordosis (40%). Labor atory tests were unhelpful and cultures of blood and disc tissue were negat ive. MRI reduces the diagnostic delay and may help to avoid the requirement for a biopsy. In 75% of cases it demonstrated a paravertebral inflammatory mass , which helped to determine the duration of the oral therapy given after in itial intravenous antibiotics. At a mean follow-up of 21 months (10 to 40), all the spines were mobile and the patients free from pain. Radiological fusion occurred in 20% and was p redictable after two years. At follow-up, MRI showed variable appearances: changes in the vertebral body usually resolved at 24 months and recovery of the disc was seen after 34 months.