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Virtual Pediatric Hospital: Back Pain in Children: Case Examples of Back Pain in Children: Case 1 Back Pain in Children: Case Examples of Back Pain in Children

Case 1

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed

A two year old female presented to the emergency room with a five week history of refusing to walk and play and back pain. On physical exam, she was found to have a fever, and no neurological deficits. Her laboratory results show an elevated white blood cell count and sedimentation rate. Clinically, this was felt to be infection.

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The imaging findings confirmed the clinical suspicion for diskitis. Blood cultures were drawn at admission and turned out to be negative. A percutaneous biopsy of the L3-L4 intervertebral disk space returned gram negative rods. The patient was treated with IV antibiotics for six weeks and recovered without complications.

Diskitis, also known as spinal osteomyelitis, is most commonly seen in children younger than 5 years. It is seen most commonly in the lumbar spine. The infection starts in the vertebral endplates, which are highly vascular in children less than 5 years old, and then spreads into the intervertebral disk space. It can be viral or bacterial in origin. Plain films may be normal in appearance for 2-4 weeks after the initial infection. After that time, plain films will show narrowing of the intervertebral disk space and erosion of the vertebral end plates. If untreated, the vertebral body can flatten in 6-10 weeks. A bone scan is positive within days of infection, showing increased uptake in the intervertebral disk space and adjacent vertebral bodies. CT and MRI can be used to investigate whether there are associated epidural abscesses or paravertebral soft tissue masses.

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