Tapia Moreno R, Espinosa Fernández M G, Martínez León M I, González Gómez J M, Moreno Pascual P
Unidad de Reumatología Pediátrica, Hospital Materno-Infantil del Complejo Hospitalario Universitario Carlos Haya, Málaga, España.
An Pediatr (Barc). 2009 Nov;71(5):391-9. doi: 10.1016/j.anpedi.2009.06.032. Epub 2009 Sep 1.
Spondylodiscitis is an uncommon disease in children. It is often misdiagnosed or the diagnosis is made late in the course of illness.
To review the clinical, analytical and radiological characteristics of children with spondylodiscitis in the Materno-Infantil Hospital of Malaga.
Retrospective cohort study on children diagnosed with spondylodiscitis, during a period of 11 years.
Eighteen patients were included in the study. Spondylodiscitis was more frequent in patients younger than 3 years old and older than 12 years old. The average time of delay in diagnosis was 26.9 days. In 8 cases the diagnosis was missed initially. Three clinical patterns appeared: in children under 3 years of age, refusing to walk and sit (100%) and irritability (42%); between 3 and 12 years of age, limb (100%) and abdominal pain (100%); in adolescents, back pain (75%). Fever was present in 38% of the cases, and low-grade fever in 8 (44%). A total of 50% of the patients had a moderate leucocytosis, and a slight increase in ESR; the most frequent location was L3-L4. X-ray diagnosis was pathological in 88% of the cases. The initial MRI diagnosed 100% of the cases. In addition, nerve roots damage (5 cases), inflammatory masses/paravertebral abscesses (5), epidural abscess (1) and psoas abscesses (2) were detected. A total of 94% of the children received antibiotics and 100% of the children underwent immobilization. All patients recovered early after the beginning of treatment, with the exception of those affected by psoas abscesses. The radiological follow-up was done in 17 patients (12 by MRI). After a mean of 14 months (rank 1-48), persistent diminution of disc space was seen in 100% of the children, and improvement of soft-tissue inflammation. Clinically (follow-up only in 11 patients) all patients regained normal mobility and only 27% had moderate pain.
Spondylodiscitis, whose delay in the diagnosis is frequent, is a serious illness. Complications include abscesses and nerve root damage. MRI is the study of choice to determine the extension to neighbouring tissues.
脊椎椎间盘炎在儿童中是一种罕见疾病。它常常被误诊，或者在病程后期才得以确诊。
回顾马拉加母婴医院中患有脊椎椎间盘炎儿童的临床、分析及放射学特征。
对11年间被诊断为脊椎椎间盘炎的儿童进行回顾性队列研究。
18名患者纳入研究。脊椎椎间盘炎在3岁以下及12岁以上患者中更为常见。诊断延迟的平均时间为26.9天。8例最初漏诊。出现三种临床模式：3岁以下儿童，拒绝行走和坐立（100%）以及易激惹（42%）；3至12岁，肢体疼痛（100%）和腹痛（100%）；青少年，背痛（75%）。38%的病例有发热，8例（44%）为低热。50%的患者有中度白细胞增多，血沉略有升高；最常见的部位是L3 - L4。88%的病例X线诊断为病理性。最初的MRI诊断出所有病例（100%）。此外，检测到神经根损伤（5例）、炎性肿块/椎旁脓肿（5例）、硬膜外脓肿（1例）和腰大肌脓肿（2例）。94%的儿童接受了抗生素治疗，100%的儿童进行了固定。除受腰大肌脓肿影响的患者外，所有患者在治疗开始后早期康复。17名患者进行了放射学随访（12例通过MRI）。平均14个月（范围1 - 48个月）后，100%的儿童椎间盘间隙持续变窄，软组织炎症有所改善。临床方面（仅11例患者进行了随访），所有患者恢复了正常活动能力，仅有27%有中度疼痛。
脊椎椎间盘炎常出现诊断延迟，是一种严重疾病。并发症包括脓肿和神经根损伤。MRI是确定向邻近组织蔓延情况的首选检查方法。
