Discitis in Children¶

Definition¶

Childhood discitis is an infection of the intervertebral disc that occurs primarily in children under age 8. Unlike adults, children retain a direct blood supply to the disc through vascular channels in the cartilaginous endplate, allowing hematogenous seeding directly into the disc. The lumbar spine (particularly L2–L4) is most commonly affected. Many cases are now considered to be low-virulence infections or inflammatory processes rather than classical pyogenic infections.

Clinical Presentation¶

• Refusal to walk, sit, or bend (in toddlers)
• Back pain or abdominal pain (in older children)
• Irritability and refusal to bear weight
• Low-grade fever (may be absent)
• Elevated ESR (most consistent lab finding); CRP may be normal

Imaging Findings¶

MRI¶

• Disc — Increased T2 signal within the affected disc, loss of the intranuclear cleft, disc narrowing
• Endplates — Edema and enhancement of the adjacent vertebral body endplates (low T1, high T2/STIR)
• Enhancement — Disc and endplate enhancement on post-contrast images
• Endplate integrity — Endplate erosion is less pronounced than in adult pyogenic spondylodiscitis (reflecting the lower virulence of the typical organisms)
• Epidural or paravertebral extension — Less common than in adult infections

Radiography¶

• Often normal early in the disease course
• Disc space narrowing (may take 2–4 weeks to become apparent)
• Endplate irregularity

Nuclear Medicine¶

• Bone scan or gallium scan may show increased uptake at the affected level before radiographic changes

Etiology¶

• Staphylococcus aureus is the most common organism when identified
• Kingella kingae is increasingly recognized, especially in children under 4
• Many cases are culture-negative (blood cultures and biopsy cultures may be negative in >50%)
• Some cases may represent a sterile inflammatory process rather than true infection

Management¶

• Antibiotics — Empiric anti-staphylococcal therapy; duration typically 4–6 weeks
• Immobilization — Bed rest or bracing for symptom relief
• Biopsy — Not routinely performed; reserved for atypical presentations or failure to respond to empiric antibiotics
• Prognosis — Excellent; most children recover fully with disc space reconstitution over time, though some residual disc narrowing and endplate irregularity may persist

Key Points¶

• Childhood discitis results from direct hematogenous seeding of the vascularized disc
• Lumbar spine is most commonly affected in children under 8
• Refusal to walk + elevated ESR is the classic presentation
• MRI shows disc T2 hyperintensity with endplate edema and enhancement
• S. aureus and Kingella kingae are the most common organisms
• Prognosis is excellent with antibiotic treatment

References¶

1. Principi N, Esposito S. Infectious discitis and spondylodiscitis in children. Int J Mol Sci. 2016;17(4):539. https://pmc.ncbi.nlm.nih.gov/articles/PMC4848995/
2. Alghamdi A. Discitis in children. Neurosciences (Riyadh). 2016;21(3):283-285. https://pmc.ncbi.nlm.nih.gov/articles/PMC5107302/
3. Samara E, Lutz N, Zambelli PY. Kingella kingae spinal infections in children. Children (Basel). 2022;9(5):705. https://pmc.ncbi.nlm.nih.gov/articles/PMC9139591/
4. Adebiyi EO, Ayoade F. Kingella Kingae. In: StatPearls. Treasure Island (FL): StatPearls Publishing; updated 2023 Jul 4. https://www.ncbi.nlm.nih.gov/books/NBK547690/
5. Expert Panel on Neurological Imaging, Ortiz AO, Levitt A, et al. ACR Appropriateness Criteria® Suspected Spine Infection. J Am Coll Radiol. 2021;18(11S):S488-S501. https://pubmed.ncbi.nlm.nih.gov/34794603/
6. Expert Panel on Pediatric Imaging, Dahmoush H, Gaddam DS, et al. ACR Appropriateness Criteria® Back Pain-Child: 2024 Update. J Am Coll Radiol. 2025;22(5S):S79-S107. https://pubmed.ncbi.nlm.nih.gov/40409897/
7. Spondylodiscitis. Radiopaedia.org. https://radiopaedia.org/articles/spondylodiscitis

Related Articles¶

• Pyogenic Spondylodiscitis
• Spinal Infection Overview