- Discitis is a rare but well-recognised entity affecting toddlers and young children typically between the third and fourth lumbar vertebrae.
- The pathogenesis is unclear but may reflect self-limited infectious or inflammatory causes.
- Children may present with back pain, limp, neck stiffness, irritability, and gastrointestinal upset. Toddlers often refuse to stand or sit and may be clearly in pain on nappy / diaper changing when the spine is flexed.
- Tenderness on palpation of the spinous processes is usually found, but the child may refuse to bend down to pick up an object.
- These poorly localized symptoms and the normal or mildly elevated complete blood count and inflammatory markers contribute to delays in diagnosis.
- Plain radiographs demonstrate disc space narrowing and irregular endplates of adjacent vertebrae but these changes can take approximately 10 days to appear. Bone scan and MRI have excellent sensitivity to detect early changes but bone scan involves considerable radiation and MRI is not readily available for many clinicians. MRI can also be helpful to exclude other pathologies such as abscess and spinal tumours.
- Treatment consists of anti-inflammatory agents, antibiotics, and immobilisation.
- The natural course of the disease is benign with the majority being asymptomatic by three weeks. Chronic spinal restriction may develop and persistent intervertebral narrowing on radiographs is common, hence ongoing follow-up is suggested.