🦴 Section 720.7 · Spine Infection (Spondylodiscitis / Discitis)

Nelson Textbook of Pediatrics 22nd Edition | Spine infection includes spondylodiscitis (discitis) and vertebral osteomyelitis. Most common in children <5 years. Presentation: refusal to walk, irritability, back pain, low-grade fever. MRI is gold standard (disc space narrowing, endplate irregularities, marrow edema). S. aureus most common; Kingella kingae in young children (6 months-4 years). Treatment: IV antibiotics 4-6 weeks (anti-staphylococcal), bracing. Surgery (biopsy/debridement) for failure to improve, abscess, or neurologic deficit. Prognosis excellent with early treatment.

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📋 30 Clinical Scenarios — Spine Infection

📇 High‑Yield Review Cards

🩺 Clinical Recognition: Spine Infection

Select a presentation to review diagnostic clues and management per Nelson 720.7.

📋 Stepwise Management of Spine Infection

🔑 Key Principles — Nelson Section 720.7
• Definition: Spondylodiscitis = primary infection of intervertebral disk with spread to vertebrae. Most common in children <5 years.
• Etiology: Hematogenous seeding. S. aureus most common. Kingella kingae common in 6 months-4 years (often subacute, milder presentation).
• Presentation: Refusal to walk, back pain, irritability, low-grade fever. Toddlers may refuse to sit or stand.
• Imaging: MRI is gold standard — shows disc space narrowing, endplate irregularity, marrow edema (STIR). Radiographs delayed (2-3 weeks for changes).
• Treatment: IV antibiotics (anti-staphylococcal) for 4-6 weeks. Bracing for pain. Surgery (biopsy, debridement) for failure to improve, abscess, or neurologic deficit.

    ⚡ Reflex Prompts — Clinical Decisions

    📖 Summary: Spine Infection (Nelson 720.7)