The Diagnosis and Management of Pediatric Spine Infections

Abstract

The management of pediatric spine infections requires a multidisciplinary approach that includes orthopedic surgeons, infectious disease specialists, interventional radiologists, and others. The prevalence of the disease has increased in frequency, virulence, and degree of soft tissue involvement over the past several years; there has also been a resurgence of some types of infections, such as tuberculosis, fungal, and viral pathogens. The diagnosis can often be reached with a detailed history, physical examination, laboratory tests, and imaging studies. Pathologies mimicking infection require a more invasive approach for diagnosis, including core or open biopsy. The treatment of discitis, spondylodiscitis, vertebral osteomyelitis, spinal epidural, and intramedullary abscesses in children is at times complex, and although many infections can be treated non-surgically with antibiotic therapy, some more extensive infections require surgical management. A timely diagnosis is important as it allows the initiation of the appropriate antimicrobial therapy and would decrease the complexity of the subsequent surgical intervention.

Keywords: ct-guided biopsy; epidural abscess; spondylodiscitis; tubercular osteomyelitis; vertebral osteomyelitis.

Figure 1. Lumbar spine x-ray of a three-year-old child with a two-week history of irritability, showing disk space narrowing of L3-L4 consistent with spondylodiscitis

Figure 2. MRI of the lumbar spine of a 14-year-old child with spondylodiscitis involving the T12 and L1 vertebras and disc

MRI, Magnetic resonance imaging.

Figure 3. Thoracolumbar spinal hardware infection in a 14-year-old child. Coronal and sagittal 18f-FDG PET/CT views of the spinal hardware extending from T6 to L4.

There is increased FDG uptake in the bone and soft tissues immediately adjacent to the hardware from T12 to L4 (arrows). FDG uptake at the bone hardware interface is present at the left L3 interpedicular screw (arrowheads). FDG, Fluorodeoxyglucose; PET, positron emission tomography; CT, computed tomography.

Figure 4. A lateral lumbar spine x-ray of a 12-year-old female

The image shows a lateral lumbar spine x-ray of a 12-year-old female that presented to our institution with a four-month history of back pain, showing loss of the disc space and junctional kyphosis at L4/L5. She was diagnosed with tuberculosis of the lumbar spine.

Figure 5. Sagittal MRI image of the lumbar spine of the same 12-year-old female with tuberculosis, showing multilevel involvement from L4 to S1 and a large anterior phlegmon

Figure 6. Image of the same 12-year-old girl with tuberculosis, after anterior L5 vertebrectomy, lumbar abscess debridement, anterior L4-S1 arthrodesis using tricortical allograft, and posterolateral arthrodesis of L4-S1