Skip to main content
SpringerLink
Log in

Pediatric Spinal Infections

  • Chapter
The Growing Spine

  • 2737 Accesses

Abstract

Spinal infections are uncommon in childhood; therefore, the clinical workup begins with a high level of suspicion. Spinal infections can be classified as either disc or vertebral body infections (i.e., discitis or verte- bral osteomyelitis, respectively). Indeed, both diseases have distinct epidemiologic, clinical, and radiographic features [78]. In this chapter, pathophysiology, clinical evaluations, and management of discitis, vertebral osteomyelitis, tuberculosis, and postoperative spinal infections observed in childhood will be reviewed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 239.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Adatepe MH, Powell OM, Isaacs GH (1986) Hematogenous pyogenic vertebral osteomyelitis: diagnostic value of radio-nuclide bone imaging. J Nucl Med 27:1680–1685

    PubMed  CAS  Google Scholar 

  2. Akhaddar A, Gourinda H, el Alami Z et al (1999) Hydatid cyst of the sacrum. Report of a case. Rev Rhum Engl Ed 66(5):289–291

    PubMed  CAS  Google Scholar 

  3. Andronikou S, Jadwat S, Douis H (2002) Patterns of disease on MRI in 53 children with tuberculous spondylitis and the role of gadolinium Pediatr Radiol 32:798–805

    Article  PubMed  Google Scholar 

  4. Bailey HL, Gabriel M, Hodgson AR et al (1972) Tuberculosis of the spine in children: operative findings and results in one hundred consecutive patients treated by removal of the lesion and anterior grafting. J Bone Joint Surg 54A: 1633–1657

    Google Scholar 

  5. Banta JV (1990) Combined anterior and posterior fusion for spinal deformity in myelomeningocele. Spine 15:946–952

    Article  PubMed  CAS  Google Scholar 

  6. Berk RH, Yazici M, Atabey N et al (1996) Detection of Mycobacterium tuberculosis in formaldehyde solution-fixed, paraffin-embedded tissue by polymerase chain reaction in Pott’s disease. Spine 21:1991–1995

    Article  PubMed  CAS  Google Scholar 

  7. Boston HC Jr, Bianco AJ Jr, Rhodes KH (1975) Disk space infections in children. Orthop Clin North Am 6:953–964

    PubMed  Google Scholar 

  8. Brook I (2001) Two cases of discitis attributable to anaerobic bacteria in children. Pediatrics 107:E26

    Article  PubMed  CAS  Google Scholar 

  9. Brown R, Hussain M, McHugh K et al (2001) Discitis in young children. J Bone Joint Surg Br 83:106–111

    Article  PubMed  CAS  Google Scholar 

  10. Butbul-Aviel Y, Koren A, Halevy R et al (2005) Procalcitonin as a diagnostic aid in osteomyelitis and septic arthritis. Pediatr Emerg Care 21(12):828–832

    Article  PubMed  Google Scholar 

  11. Cheng MT, Chang MC, Wang ST et al (2005) Efficacy of dilute betadine solution irrigation in the prevention of postoperative infection of spinal surgery. Spine 30:1689–1693

    Article  PubMed  Google Scholar 

  12. Chew FS, Kline MJ (2001) Diagnostic yield of CT-guided percutaneous aspiration procedures in suspected spontaneous infectious discitis. Radiology 218:211–214

    PubMed  CAS  Google Scholar 

  13. Clark CE, Shufflebarger HL (1999) Late-developing infection in instrumented idiopathic scoliosis. Spine 24: 1909–1912

    Article  PubMed  CAS  Google Scholar 

  14. Collins I, Wilson-MacDonald J, Chami G et al (2008) The diagnosis and management of infection following instrumented spinal fusion. Eur Spine J 17: 445–450. doi:10.1007/ s00586-007-0559-8

    Article  PubMed  Google Scholar 

  15. Correa AG, Edwards MS, Baker CJ (1993) Vertebral osteomyelitis in children. Pediatr Infect Dis J 12:228–233

    Article  PubMed  CAS  Google Scholar 

  16. Coventry MB, Ghormley RK, Kernohan JW (1945) The intervertebral disc: its microscopic anatomy and pathology: I. Anatomy, development, and physiology. J Bone Joint Surg 27:105–112

    Google Scholar 

  17. Crawford AH, Kucharzyk DW, Ruda R, Smitherman HC Jr (1991) Discitis in children. Clin Orthop 266:70–79

    PubMed  Google Scholar 

  18. Cushing AH (1993) Discitis in children. Clin Infect Dis 17:1–6

    Article  PubMed  CAS  Google Scholar 

  19. Dagirmanjian A, Schils J, McHenry M (1996) MR imaging of vertebral osteomyelitis revisited. AJR Am J Roentgenol 167:1539–1543

    Article  PubMed  CAS  Google Scholar 

  20. Diab MA, Erickson MA, Dormans JP et al (2007) Use and outcome of wound drain in children undergoing operation for idiopathic scoliosis. In: 42nd Annual Meeting of Scoliosis Research Society, Edinburgh, Scotland

    Google Scholar 

  21. Donovan Post MJ, Bowen BC, Sze G (1991) Magnetic resonance imaging of spinal infection. Rheum Dis Clin North Am 17:773–794

    Google Scholar 

  22. Dormans JP, Moroz L (2007) Infection and tumors of the spine in children. J Bone Joint Surg Am 89:79–97

    Article  PubMed  Google Scholar 

  23. Du Lac P, Panuel M, Devred P et al (1990) MRI of disc space infection in infants and children: report of 12 cases. Pediatr Radiol 20:175–178

    Article  PubMed  Google Scholar 

  24. Dumanian GA, Ondra SL, Liu J et al (2003) Muscle flap salvage of spine wounds with soft tissue defects or infection. Spine 28(11):1203–1211

    PubMed  Google Scholar 

  25. Early SD, Kay RM, Tolo VT (2003) Childhood discitis. J Am Acad Orthop Surg 11:413–420

    PubMed  Google Scholar 

  26. Eismont FJ, Bohlman HH, Soni PL et al (1982) Vertebral osteomyelitis in infants. J Bone Joint Surg Br 64:32–35

    PubMed  CAS  Google Scholar 

  27. Fernandez M, Carrol CL, Baker CJ (2000) Discitis and vertebral osteomyelitis in children: an 18-year review. Pediatrics 105:1299–1304

    Article  PubMed  CAS  Google Scholar 

  28. Fisher GW, Popich GA, Sullivan DE et al (1978) Discitis: a prospective diagnostic analysis. Pediatrics 62:543–548

    Google Scholar 

  29. Gabriel KR, Crawford AH (1988) Magnetic resonance imaging in a child who had clinical signs of discitis: report of a case. J Bone Joint Surg Am 70:938–941

    PubMed  CAS  Google Scholar 

  30. Galil A, Gorodischer R, Bar-Ziv J et al (1982) Intervertebral disc infection (discitis) in childhood. Eur J Pediatr 139: 66–70

    Article  PubMed  CAS  Google Scholar 

  31. Garron E, Viehweger E, Launay F (2002) Nontuberculous spondylodiscitis in children. J Pediatr Orthop 22:321–328

    PubMed  Google Scholar 

  32. Glazer PA, Hu SS (1996) Pediatric spinal infections. Orthop Clin North Am 27:111–123

    PubMed  CAS  Google Scholar 

  33. Grünebaum M, Horodniceanu C, Mukamel M et al (1982) The imaging diagnosis of nonpyogenic discitis in children. Pediatr Radiol 12:133–137

    Article  PubMed  Google Scholar 

  34. Ha KY, Chung YG, Ryoo SJ (2005) Adherence and bio-film formation of Staphylococcus epidermidis and Myco-bacterium tuberculosis on various spinal ımplants. Spine 30(1):38–43

    PubMed  Google Scholar 

  35. Hahn F, Zbinden R, Min K (2005) Late implant infections caused by Propionibacterium acnes in scoliosis surgery. Eur Spine J 14:783–788

    Article  PubMed  Google Scholar 

  36. Harisinghani MG, McLoud TC, Shepard JO et al (2000) Tuberculosis from head to toe. Radiographics 20:449–470

    PubMed  CAS  Google Scholar 

  37. Hasley BP, McClung A, Sucato DJ (2007) Closed suction drainage following posterior spinal fusion for adolescent idiopathic scoliosis: is it necessary? In: 42nd Annual Meeting of Scoliosis Research Society, Edinburgh, Scotland

    Google Scholar 

  38. Heller RM, Szalay EA, Green NE et al (1988) Disc space infection in children: magnetic resonance imaging. Radiol Clin North Am 26:207–209

    PubMed  CAS  Google Scholar 

  39. Ho C, Skaggs DL, Weiss JM et al (2007) Management of infection after instrumented posterior spine fusion in pediat-ric scoliosis. Spine 32:2739–2744

    Article  PubMed  Google Scholar 

  40. Ho C, Sucato DJ, Richards BS (2007) Risk factors for the development of delayed infections following posterior spinal fusion and instrumentation in adolescent idiopathic sco-liosis patients. Spine 32:2272–2277

    Article  PubMed  Google Scholar 

  41. Jones GA, Butler J, Lieberman I et al (2007) Negative-pressure wound therapy in the treatment of complex postoperative spinal wound infections: complications and lessons learned using vacuum-assisted closure. J Neurosurg Spine 6(5):407–411

    Article  PubMed  Google Scholar 

  42. Jung NY, Jee WH, Ha KY et al (2004) Discrimination of tuberculous spondylitis from pyogenic spondylitis on MRI. AJR Am J Roentgenol 182(6):1405–1410

    Article  PubMed  Google Scholar 

  43. Kayser R, Mahlfeld K, Greulich M et al (2005) Spondylo-discitis in childhood: results of a long-term study. Spine 30(3):318–323

    Article  PubMed  Google Scholar 

  44. Kemp HBS, Jackson JW, Jeremiah JD et al (1973) Pyogenic infections occurring primarily in intervertebral discs. J Bone Joint Surg Br 55:698–714

    PubMed  CAS  Google Scholar 

  45. King HA (1999) Back pain in children. Orthop Clin North Am 30:467–474

    Article  PubMed  CAS  Google Scholar 

  46. Klein JD, Hey LA, Yu CS et al (1996) Perioperative nutrition and postoperative complications in patients undergoing spinal surgery. Spine 21:2676–2682

    Article  PubMed  CAS  Google Scholar 

  47. Lichtor J, Lichtor A (1957) Paleopathological evidence suggesting pre-Columbian tuberculosis of spine. J Bone Joint Surg Am 39:1938–1939

    Google Scholar 

  48. Loke TK, Ma HT, Chan CS (1997) MRI of tuberculous spinal infection. Australas Radiol 41:7–12

    Article  PubMed  CAS  Google Scholar 

  49. Magera BE, Klein SG, Derrick CW Jr et al (1989) Radiological cases of the month. Am J Dis Child 143: 1479–1480

    PubMed  CAS  Google Scholar 

  50. Mahboubi S, Morris MC (2001) Imaging of spinal infections in children. Radiol Clin North Am 39:215–222

    Article  PubMed  CAS  Google Scholar 

  51. Maliner LI, Johnson DL (1997) Intervertebral disc space inflammation in children. Childs Nerv Syst 13:101–104

    Article  PubMed  CAS  Google Scholar 

  52. McCarthy RE, Peek RD, Morrisy RT et al (1986) Allograft bone in spinal fusion for paralytic scoliosis. J Bone Joint Surg Am 68:370–375

    PubMed  CAS  Google Scholar 

  53. Mehbod AA, Ogilvie JW, Pinto MR et al (2005) Postoperative deep wound infections in adults after spinal fusion: management with vacuum-assisted wound closure. J Spinal Disord Tech 18(1):14–17

    Article  PubMed  CAS  Google Scholar 

  54. Menelaus MB (1964) Discitis: an inflammation affecting the intervertebral discs in children. J Bone Joint Surg Br 46:16–23

    PubMed  CAS  Google Scholar 

  55. Miller GM, Forbes GS, Onofrio BM (1989) Magnetic resonance imaging of the spine. Mayo Clin Proc 64:986–1004

    Article  PubMed  CAS  Google Scholar 

  56. Mitra A, Mitra A, Harlin S (2004) Treatment of massive tho-racolumbar wounds and vertebral osteomyelitis following scoliosis surgery. Plast Reconstr Surg 113:206–213

    Article  PubMed  Google Scholar 

  57. Modic MT, Pavlicek W, Weinstein MA et al (1984) Magnetic resonance imaging of intervertebral disk disease: clinical and pulse sequence considerations. Radiology 152:103–111

    PubMed  CAS  Google Scholar 

  58. Modic MT, Feiglin DH, Piraino DW et al (1985) Vertebral osteomyelitis: assessment using MR. Radiology 157:157–166

    PubMed  CAS  Google Scholar 

  59. Moon MS, Woo YK, Lee KS et al (1995) Posterior instrumentation and anterior interbody fusion for tuberculous kyphosis of dorsal and lumbar spines. Spine 20:1910–1916

    Article  PubMed  CAS  Google Scholar 

  60. Muschik M, Luck W, Schlenzka D (2004) Implant removal for late-developing infection after instrumented posterior spinal fusion for scoliosis: reinstrumentation reduces loss of correction. A retrospective analysis of 45 cases. Eur Spine J 13:645–651

    Article  PubMed  Google Scholar 

  61. Ng Alex WH, Chu Winnie CW, Ng Bobby KW et al (2005) Extensive paraspinal abscess complicating tuberculous spon-dylitis in an adolescent with Pott kyphosis. J Clin Imaging 29:359–361

    Article  CAS  Google Scholar 

  62. Oga M, Arizono T, Takasita M et al (1993) Evaluation of the risk of instrumentation as a foreign body in spinal tuberculosis. Spine 18:1890–1894

    Article  PubMed  CAS  Google Scholar 

  63. Paushter DM, Modic MT, Masaryk TJ (1985) Magnetic resonance imaging of the spine: applications and limitations. Radiol Clin North Am 23:551–562

    PubMed  CAS  Google Scholar 

  64. Potter BK, Kirk KL, Shah SA et al (2006) Loss of coronal correction following instrumentation removal in adolescent idiopathic scoliosis Spine 31(1):67–72

    Article  PubMed  Google Scholar 

  65. Pui MH, Mitha A, Rae WI et al (2005) Diffusion-weighted magnetic resonance imaging of spinal infection and malignancy. J Neuroimaging 15:164–170

    PubMed  Google Scholar 

  66. Rajasekaran S, Soundarapandian S (1989) Progression of kyphosis in tuberculosis of the spine treated by anterior arthrodesis. J Bone Joint Surg 71A:1314–1323

    Google Scholar 

  67. Rajasekaran S (2001) The natural history of post-tubercular kyphosis in children radiological signs which predict late ıncrease ın deformity. J Bone Joint Surg Br 83-B:954–962

    Article  Google Scholar 

  68. Rajasekaran S (2002). The problem of deformity in spinal tuberculosis. Clin Orthop Relat Res (398):85–92

    Article  PubMed  Google Scholar 

  69. Rajasekaran S (2007) Buckling collapse of the spine in childhood spinal tuberculosis. Clin Ortho Rel Res 460: 86–92

    CAS  Google Scholar 

  70. Ratcliffe JF (1985) Anatomic basis for the pathogenesis and radiologic features of vertebral osteomyelitis and its differentiation from childhood discitis: a microarteriographic investigation. Acta Radiol Diagn (Stockh) 26:137–143

    CAS  Google Scholar 

  71. Rathjen K, Wood M, McClung A et al (2007) Clinical and radiographic results after implant removal in idiopathic sco-liosis. Spine 32:2184–2188

    Article  PubMed  Google Scholar 

  72. Richards BS (1995) Delayed infections following posterior spinal instrumentation for the treatment of idiopathic scoliosis. J Bone Joint Surg Am 77:524–529

    PubMed  CAS  Google Scholar 

  73. Richards BS, Emara KM (2001) Delayed infections after posterior TSRH spinal instrumentation for idiopathic scolio-sis: revisited. Spine 26:1990–1996

    Article  PubMed  CAS  Google Scholar 

  74. Ring D, Johnston CE II, Wenger DR (1995) Pyogenic infectious spondylitis in children: the convergence of discitis and vertebral osteomyelitis. J Pediatr Orthop 15:652–660

    Article  PubMed  CAS  Google Scholar 

  75. Rocco HD, Eyring EJ (1972) Intervertebral disk infections in children. Am J Dis Child 123:448–451

    PubMed  CAS  Google Scholar 

  76. Rothman SLG (1996) The diagnosis of infections of the spine by modern imaging techniques. Orthop Clin North Am 27:15–31

    PubMed  CAS  Google Scholar 

  77. Rumana M, Mahadevan A, Nayil Khurshid M et al (2006) Cestode parasitic infestation: intracranial and spinal hydatid disease - a clinicopathological study of 29 cases from South India. Clin Neuropathol 25(2):98–104

    PubMed  CAS  Google Scholar 

  78. Sapico FL, Montgomerie JZ (1979) Pyogenic vertebral osteomyelitis: report of nine cases and review of the literature. Rev Infect Dis 1:754–776

    Article  PubMed  CAS  Google Scholar 

  79. Song KS, Ogden JA, Ganey T et al (1997) Contiguous discitis and osteomyelitis in children. J Pediatr Orthop 17:470–477

    PubMed  CAS  Google Scholar 

  80. Soultanis K, Mantelos G, Pagiatakis A et al (2003) Late infection in patients with scoliosis treated with spinal instrumentation. Clin Orthop Relat Res 411:116–123

    Article  PubMed  Google Scholar 

  81. Spiegel PG, Kengla KW, Isaacson AS et al (1972) Intervertebral disc-space inflammation in children. J Bone Joint Surg Am 54:284–296

    PubMed  CAS  Google Scholar 

  82. Sponseller PD, LaPorte DM, Hungerford MW et al (2000) Deep wound infections after neuromuscular scoliosis surgery: a multicenter study of risk factors and treatment outcomes. Spine 25:2461–2466

    Article  PubMed  CAS  Google Scholar 

  83. Szalay EA, Green NE, Heller RM et al (1987) Magnetic resonance imaging in the diagnosis of childhood discitis. J Pediatr Orthop 7:164–167

    Article  PubMed  CAS  Google Scholar 

  84. Szoke G, Lipton G, Miller F et al (1988) Wound infection after spinal fusion in children with cerebral palsy. J Pediatr Orthop 18:727–733

    Google Scholar 

  85. Szypryt EP, Hardy JG, Hinton CE et al (1988) A comparison between magnetic resonance imaging and scintigraphic bone imaging in the diagnosis of disc space infection in an animal model. Spine 13:1042–1048

    Article  PubMed  CAS  Google Scholar 

  86. Talu U, Gogus A, Ozturk C et al (2006) The role of posterior instrumentation and fusion after anterior radical debridement and fusion in the surgical treatment of spinal tuberculosis: experience of 127 cases. J Spinal Disord Tech 19(8): 554–559

    Article  PubMed  Google Scholar 

  87. Tuli SM (2007). Tuberculosis of the Spine A Historical Review. Clin Ortho and Rel Res 460:29–38

    CAS  Google Scholar 

  88. Upadhyay SS, Sail MJ, Sell P et al (1994) Spinal deformity after childhood surgery for tuberculosis of the spine a comparison of radical surgery and debridement. J Bone Joint Surg Br 76:91–98

    PubMed  CAS  Google Scholar 

  89. van Rhee M, de Klerk L, Verhaar J (2007) Vacuum-assisted wound closure of deep infections after instrumented spinal fusion in six children with neuromuscular scoliosis Spine J 7:596–600

    Article  PubMed  Google Scholar 

  90. Vicario C, de Juan J, Esclarin A, Alcobendas M (2007) Treatment of deep wound infections after spinal fusion with a vacuum-assisted device in patients with spinal cord injury. Acta Orthop Belg 73(1):102–106

    PubMed  Google Scholar 

  91. Wenger DR, Bobechko WP, Gilday DL (1978) The spectrum of intervertebral disc-space infection in children. J Bone Joint Surg 60A:100–108

    Google Scholar 

  92. Whalen JL, Parke WW, Mazur JM et al (1985) The intrinsic vasculature of developing vertebral end plates and its nutritive significance to the intervertebral discs. J Pediatr Orthop 5:403–410

    Article  PubMed  CAS  Google Scholar 

  93. Wiley AM, Trueta J (1959) The vascular anatomy of the spine and its relationship to pyogenic vertebral osteomyelitis. J Bone Joint Surg Br 41:796–809

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Istanbul Spine Center, Florence Nightingale Hospital Sisli, Istanbul, 34403, Turkey

    Ahmet Alanay

Authors
  1. Ahmet Alanay
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. ĺbrahim Akel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ahmet Alanay .

Editor information

Editors and Affiliations

  1. Orthopaedic Surgery, San Diego Medical Director, San Diego Center for Spinal Disorders, University of California, 4130 La Jolla, Village Drive, La Jolla, CA, 92037, USA

    Behrooz A. Akbarnia MD

  2. Orthopaedic Surgery Department of Orthopaedics & Traumatology, Hacettepe University, 06100 Sihhiye, Ankara, Turkey

    Muharrem Yazici MD

  3. Pediatric Orthopaedics Rainbow Babies & Children’s Hospital, Case Western Reserve University, 11000 Euclid Avenue, Cleveland, OH, 44106-6003, USA

    George H. Thompson MD

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Alanay, A., Akel, ĺ. (2011). Pediatric Spinal Infections. In: Akbarnia, B.A., Yazici, M., Thompson, G.H. (eds) The Growing Spine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-85207-0_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-540-85207-0_10

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-85206-3

  • Online ISBN: 978-3-540-85207-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation