Editor in Chief
Infections of the spinal axis in children are rare. They encompass a large spectrum of diseases ranging from the relatively benign diskitis to the rapidly progressive, rare, and potentially devastating spinal epidural, subdural, and intramedullary spinal cord infections.
The ability to diagnose infectious processes has advanced markedly with the development of MRI and other technological advances. However, clinical awareness continues to be key for diagnosis and timely treatment as new challenges arise. The HIV pandemic has brought with it infections rarely encountered previously, and there also has been a resurgence of such historically significant infections as spinal tuberculosis. Instrumentation, which has been a major advance in the ability to reconstruct the spine after deformity or trauma, also adds a new challenge to treating spinal infections in the presence of a foreign body.
This chapter focuses on the anatomy of the pediatric spine, with emphasis on what makes it prone to specific infectious processes, the various infections common in the pediatric spine, and the diagnosis and treatment of these disorders.
- Diskitis rare in children: Inflammation of the intervertebral disk is an uncommon entity. Noniatrogenic cases of diskitis are seen almost exclusively in children. Etiology remains controversial. Recent studies have shown difficulty in isolating a particular causative organism via direct biopsy (identified in 60–82% of cases) (144, 145).
- Vertebral osteomyelitis rare, occurring in older children: Osteomyelitis remains a rare entity in children, accounting for only 1–2% of cases. It typically affects older children, with the average age at presentation being greater than 7 years. The infection usually is localized to the lumbar or thoracic regions. The most often isolated organism in vertebral osteomyelitis is Staphylococcus aureus.
- Spinal epidural and intradural, intramedullary abscesses extremely rare: Epidural abscesses of the spine are extremely rare in children. Intramedullary spinal cord abscesses in children are also a rare entity.
- Progressive neurological deficit common at presentation, with or without pain: Progressive sensory and motor losses are the clinical picture, and pain is often absent. The signs and symptoms depend on the location of the lesion; thoracolumbar segments and midthoracic segments are the most commonly areas involved.
- Meningitis or myelitis and a dermal sinus suggest an intramedullary abscess: The diagnosis of intramedullary abscess should be considered and aggressively ruled out in any patient with a dermal sinus who presents with symptoms of a partial or complete transverse myelitis or meningitis. Immediate contrast MRI at the region of dermal sinus is a useful step.