Spondylodiscitis in childhood: results of a long-term study

Abstract

Study design: Retrospective study to gather long-term data clinical, paraclinical, and radiographic data on nonoperatively managed cases of childhood spondylodiscitis.

Objectives: To analyze and assess the clinical, laboratory, and radiologic findings in children with spondylodiscitis and to document the efficacy of conservative treatment based on the long-term clinical, functional, and radiologic outcomes of these patients.

Summary of background data: Childhood spondylodiscitis is an extremely rare entity that often presents an nonspecific clinical picture. Treatment strategies are mainly conservative. Assessment of the clinical and radiologic outcomes of these patients is essential for prognosis and for justification of nonoperative management.

Methods: According to our hospital records, 25 children (17 girls and 8 boys) with a mean age of 6.1 years (range: 2 months-12 years) were hospitalized for spondylodiscitis between 1968 and 1988. Parameters related to the duration of symptoms, clinical manifestations, diagnostic workup, and course of treatment were reviewed. Twenty of the patients (75%) returned for clinical and radiologic follow-up at least 10 years after discharge (range 10-23 years).

Results: All of the patients presented with uncharacteristic signs and symptoms. Laboratory markers of inflammation were only moderately elevated. On average, the diagnosis of spondylodiscitis was established after a delay of 14 weeks (range 2 days-60 weeks). All levels of the spine were affected, whereby the thoracic and lumbar spine were preferential sites. The radiographic studies revealed destruction of adjacent vertebral bodies in 12 cases (48%). The remaining 13 patients (52%) had isolated disc involvement without radiographically detectable bone destruction. An abscess was detected by computed tomography in only 1 case. At the time of follow-up, 16 patients (80%) were asymptomatic and had unrestricted spinal mobility. Four patients (20%) had restricted spinal mobility with local kyphosis, which could be documented objectively on radiograph film. In 12 cases (60%), healing was accompanied by fibrous ankylosis and high-grade narrowing of the intervertebral disc space, as was demonstrated radiologically. Eight patients (40%) exhibited fusion of the vertebrae (4 partial, 4 complete). Four patients (20%) had residual defects.

Conclusions: Our study shows that the course of childhood spondylodiscitis is generally benign. Segmental orbony ankylosis may occur during the healing process but normally does not lead to serious functional deficits. Neurologic deficits were not observed in any of our patients. Conservative management must be intensive, but the results are good. Biopsy is not required except in the few cases where diagnostic uncertainty prevails.