Spondylodiscitis in childhood: Case report and literature review

Česká verzia

Authors: Š. Fingerhutová ¹; J. Kryl ²; P. Klement ¹; L. Koumarová ¹; J. Štulík ²; P. Szitányi ¹; J. Zeman ¹; P. Doležalová ¹
Authors place of work: Klinika dětského a dorostového lékařství 1. LF UK a VFN, Praha přednosta prof. MUDr. J. Zeman, DrSc. ¹; Oddělení spondylochirurgie 1. LF UK a FN Motol, Praha přednosta prof. MUDr. J. Štulík, CSc. ²
Published in the journal: Čes-slov Pediat 2016; 71 (5-6): 281-286.
Category: Kazuistika

Summary

Spondylodiscitis in childhood is a rare disease of unknown etiology mainly affecting preschool and younger school children. This inflammation affects the disc space as well as the adjacent vertebral bodies. The lumbar and lumbosacral areas are typically affected. It occurs most commonly in children aged two to eight years. This case report presents the case of a five year old girl with prolonged abdominal pain without any other accompanying gastrointestinal symptoms. She also manifested verticalization problems, limping, myopathic climbing (Gower´s sign) and back pain induced by gentle percussion. She was suffering from herpes zoster on her back. Muscle tests (CMAS – Childhood Myositis Assessment Scale and MMT8 – Manual Muscle Testing) confirmed proximal muscle weakness. Neurological examination revealed a decrease in tendon reflexes. Aminotransferase and creatine kinase levels were normal. MRI images displayed a narrowing of the disc space and an initial fusion of the adjacent vertebral bodies affecting the second and third lumbar vertebrae – the sign of a healing spondylodiscitis. Infectious etiology was not confirmed. The patient was treated with ampicilin and aciclovir. She also wore a corset. MRI sequences performed following the aforementioned treatment were normal.

Conclusion:
Clinical features of spondylodiscitis are non-specific. Cooperation between many medical specialities in diagnosing this unit is imperative (paediatrics, orthopedics, radiology). Patients´ outcome depends on the degree of destructive changes affecting the vertebrae. Only a small portion of children need surgical intervention as a part of the treatment.

Key words:
spondylodiscitis, discitis, back pain, abdominal pain, radiculopathy, vertebral osteomyelitis, myositis, herpes zoster.

Zdroje

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