Nonspecific diskitis in children. A nonmicrobial disease?

Eighteen patients were treated for nonspecific diskitis (diskitis without microbial cause) at the University Children's Hospital in Helsinki during 1970-1990. The mean age at admission was three years three months. The characteristic findings were restriction of spinal mobility and an elevated erythrocyte sedimentation rate (ESR). Radiographic narrowing of the affected disk space was seen four to five weeks after the initial symptoms. An operative biopsy was made in 16 patients, the histologic diagnosis being chronic or subacute nonspecific inflammation in ten, other nonspecific changes in two, and normal tissue in five. Treatment was either bed rest and antimicrobial medication, or bed rest alone. After a follow-up period of five months to nine years, all patients were clinically normal. All but two had radiographic signs of healed disk space defects. Nonspecific diskitis in children is an entity with unknown cause. The clinical picture is typical, but diagnostic difficulties may be encountered during the first weeks when radiographic signs are absent. The disease is self-limiting in most cases, and only minor radiographic changes remain after healing. The results after routine operative biopsy raise the question of a possible nonmicrobial cause.