DESCRIPTION

Often benign, self-limited infectious and/or inflammatory process of an intervertebral disc, typically of the lumbar spine; also referred to as toddler’s discitis or spondylodiscitis if it involves the adjacent vertebrae

EPIDEMIOLOGY

• >50% of the cases occur in children <4 years of age. Peak incidence is between 0 and 2 years of age.
• Triphasic age distribution
  • Weeks to months old
  • 6 months to 4 years old
  • School-age children >10 years old
• Limited data regarding incidence; becoming more frequent with availability of MRI but still considered rare
• 3% of prospectively identified pediatric musculoskeletal infections in an industrialized country
• May be more common in developing countries

ETIOLOGY

• Idiopathic/inflammatory
• Traumatic
• Infectious: bacterial
  • Staphylococcus aureus
  • Kingella kingae
  • Brucella
  • Bartonella
  • Atypical bacterial: Mycobacterium tuberculosis
• Infectious: fungal (in immunocompromised patients)
  • Aspergillus
  • Candida
  • Cryptococcus neoformans

PATHOPHYSIOLOGY

• Hematogenous spread of bacteria to vertebral bodies and subsequently to the intervertebral disc, causing active infectious process and/or localized inflammatory response
• May not represent active infection; can be a benign self-limited inflammatory process
• May have a preceding nonspecific viral illness suggesting postinfectious phenomenon
• Can be a late complication after ingested button battery is removed