[Discitis in children less than 3 years old: a case series and literature review]

Abstract

Objective: Review of the cases of discitis treated in our unit in children under 3 years old.

Material and method: A retrospective medical record review was made of 10 cases with a diagnosis of discitis at discharge, in children hospitalized from January 1998 to December 2010.

Results: The most affected level was L5-S1 (4 cases), followed by L4-L5 (3 cases). The history at presentation was non-specific and caused a delay in the diagnosis of 3.7 weeks, and a wrong initial diagnosis in 7 patients. Most frequent symptoms were the refusal to sit (70%) and an alteration in gait or refusal to walk (50%), with pain at spinal palpation (80%), and stiffness (70%). All patients had unspecific laboratory test anomalies, and radiographs were normal in 6 patients. Magnetic resonance imaging (MRI) was performed on 9 patients and was diagnostic in all of them. All patients were treated and remain asymptomatic after a mean follow-up of 24.2 months, but radiographic abnormalities persist in 80% of them.

Discussion: The diagnosis of discitis is difficult in patients under 3 years due to the absence of specific clinical and laboratory findings. Magnetic resonance is the tool of choice to make the diagnosis. Treatment consists of a combination of antibiotics and orthosis. Radiological abnormalities persist in the majority of cases.

Conclusions: In patients under 3 years with the suspected diagnosis of discitis, MRI should be considered in the diagnosis of discitis. Symptoms resolve with antibiotics and immobilization. Because of the persistency of the radiographical abnormalities, a long-term period of follow-up is advised to detect long-term sequelae.

Keywords: Child; Delayed diagnosis; Discitis; Espondilodiscitis; Niño; Retraso en el diagnóstico; Spondylodiscitis.