11 Year Old With Right Sided Back Pain

Jonathan Gordon, M.D., Ph.D.

July 27, 2004


In children, isolated diskitis typically occurs in patients less than 3 years old, however, vertebral osteomyelitis usually occurs in patient's older than 8 years. Infection is usually caused by Staphylococcus or Streptococcus organisms. These may enter through the vertebral arteries or Batson's vertebral venous plexus which is usually the source of infection following urinary tract surgery. Osteomyelitis may present with fever or back pain with or without impairment of the lower extremities. Blood cultures are typically positive in febrile patients. Radiographically, there is a classic loss of disk space height as the disk is destroyed by bacterial enzymes. Vertebral body destruction occurs in subacute to chronic stages. Tuberculous spondylitis typically spares the disk space. On MRI, early osteomyelitis may be revealed through marrow edema with intense disk enhancement following contrast administration - pathognomonic for diskitis. Subligamentous spread to multiple vertebral levels as well as the paraspinous soft tissues is not uncommon. In children, the disk is usually affected first due to its vascular supply which diminishes in adulthood. Adults typically begin with vertebral osteomyelitis which extends into the disk space. Complications include spinal epidural abscess which may result in cord compression, kyphosis from anterior fusion of vertebral bodies or marked vertebral body destruction resulting in deformity. In children with isolated diskitis, the disk space may return to its normal height within 2 to 3 years although fusion occurs in 20% of cases.

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