Pyogenic Spinal Infections Without Disc Involvement in Childhood
Abstract
Introduction: Pyogenic spinal infections in children include spondylodiscitis, spondylitis, facet joint septic arthritis, paraspinal and perivertebral abscesses, meningitis, myelitis, and their associations. Staphylococcus aureus is the most common causative microorganism. Objective: To determine the prevalence of spinal bone infections and pyogenic perivertebral abscesses in children and to evaluate the usefulness of Ju’s algorithm. Materials and Methods: Nine children without comorbidities presenting with pyogenic spinal infection and preserved disc integrity were included. Results: A higher frequency was observed in children older than eight years. The most prevalent clinical triad was pain, fever, and antalgic postures. Ju’s algorithm proved to be reliable. One case of facet joint septic arthritis, four cases of spondylitis, and eight perivertebral abscesses were identified, five associated with bone infection. On CT, bone lesions showed a lytic or mottled appearance, while MRI demonstrated typical infectious patterns. Bone specimens obtained by percutaneous and transoral biopsy confirmed acute osteomyelitis. S. aureus was isolated in seven of nine patients. Antibiotic therapy was effective; however, six children required surgery: five for abscess drainage and one for a pedicle subtraction osteotomy due to residual kyphosis. Conclusions: Spinal infection with preserved disc integrity was prevalent in late childhood and adolescence. Its association with abscess formation and S. aureus infection was significant. We recommend the application of Ju’s algorithm and, in cases of negative blood cultures, performing bone biopsy for bacteriological identification and histopathological confirmation, surgical drainage of soft tissue abscesses, and targeted antibiotic therapy.Downloads
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