Nontuberculous spondylodiscitis in children

Abstract

Forty-two children with nontuberculous spondylodiscitis treated between 1966 and 1997 were reviewed, and the clinical, paraclinical, and therapeutic results are presented. The study shows the difficulties of diagnosis and understanding the pathophysiology of the disease. Additional information is provided by new imaging techniques, disc aspiration, and biopsy. The mean age at treatment was 4 years 6 months. The initial clinical presentation was often misleading and the diagnosis was often delayed (42 days average). Standard radiographs and technetium bone scans were important for diagnosis and patient follow-up. Magnetic resonance imaging and needle aspiration of the disc gave an additional reliable aid in differential diagnosis and helped to guide treatment. Bacteria were isolated in 22 of the 35 samples taken (55% Staphylococcus aureus, 27% Kingella kingae; Coxiella burnetii in one sample). The functional outcome is good if treatment is properly carried out. Disc fibrosis and occasional vertebral fusion develop inevitably in the long term. According to these results, nontuberculous spondylodiscitis is truly osteomyelitis of the spine.