Remodeling of the spine in spondylodiscitis of children at the age of 3 years or younger.

Spondylitis/spondylodiscitis is still an uncommon diagnosis often with a delay in diagnosis and treatment due to the uncharacteristic symptoms. The aim of this study is to increase the awareness and outline a pattern of investigation and treatment. We present six children with an average age of 23 months (19-33 months) at time of diagnosis, conservative treated and with a mean follow-up of 31 months (12-65 months). The evaluation included past medical history, clinical symptoms, X-rays, MRI-investigations and laboratory studies [CRP, erythrocytes sedimentation rate (ESR), white blood count (WBC) and blood cultures] during the course of treatment and follow-up. The predominate clinical findings were: limp, refusal to walk and/or back pain. The mean duration of symptoms until presentation at our clinic was 24 days (4-42 days), the final diagnosis was set after an average of 12 days (7-14 days). Laboratory findings were unspecific but ESR best correlated with the clinical symptoms during the therapy. Five patients were treated by parenteral antibiotics for a minimum of 3 weeks, followed by oral antibiotics adapted to the clinical and laboratory findings. One child received a combined antituberculous chemotherapy after positive skin test for tbc. All six children were immobilized with a body-plaster-cast for an average time of 15 weeks (5-26 weeks). Four patients additionally were treated by further corset therapy for an average of 10 months (3-18 months). Radiological findings on plane X-rays (a.p. and lateral views) at time of diagnosis were decreased height of the disk space and erosions of adjacent vertebral endplates and residues of these radiological changes with signs of bony healing (sclerotic vertebral endplates or partial fusion) were seen at the latest follow-up. There was no case of instability or deformity like scoliosis or kyphosis. The MRI showed the earliest detectable typical vertebral bone involvements and confirmed the diagnosis in combination with laboratory findings and clinical symptoms. Spondylitis/spondylodiscitis should be considered as diagnosis in children with refusal to walk or gait disturbances especially in combination with elevated ESR. MRI is the tool of choice to set the diagnosis early. With an adequate and early therapy of bracing (body-plaster-cast), antibiotics and clinical monitoring good long-term result without spine instability or deformity can be achieved.