Dirk Schaper, V. Hofmann (Halle/S.)  

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4 Years  

Male  

Spinal canal / Myelon  

inflammatory or infectious  

4 year-old boy with pain in the right hip after fall. Shooting pain with inability to walk. The patient presented uncharacteristic symptoms various times in several institutions. Patient refused to sit or stand. Presentation to child- and juvenile psychologists. Presentation in our clinic because of continuing pain. CRP and ESR were increased, further values were normal. Pain in the right proximal thigh. Notable waddling gait, hyperlordosis of the lumbar spine.  

Probably inflammatory origin.  

<- view X-Ray 1

X-ray 1: Obvious narrowing of the intervertebral space L4/5






<- view MRI 1

MRI 1: T1: steep presentation of the spinal column, signal reduction in L4 and L5. Narrowed disc, dorsal protrusion into the spinal column.






<- view MRI 2

MRI 2: T2 clear signal increase in the corresponding vertebral bodies and in the disc L4/5






<- view MRI 3

MRI 3: after treatment, no proof of inflammatory changes. Obvious flattening of the disc.





 

Total constellation (Consens)  

Spondylitis, Vertebral body osteomyelitis  

Immobilization in bed and antibiotic treatment in spite of missing pathogenic proof. Fitting of a corset. Slow decline of the BSR. Further immobilization in the corset also in the mobilization phase. Increased mobilization in the course of the illness, trouble-free gait. In the follow-up MR image, proof of the narrowing disc. At present, the paitent reports no troubles, and has a full sport capacity.  

The patient's history and the progress of the patient fits well with some already-published cases. The typical "not wanting to stand or sit" is, in otherwise uncharacteristic symptoms, not a strong enought statement to make a diagnosis. One should give this main symptom of Spondylodiscitis more notice, in order to avoid long misleading courses. The necessity of an antibiotic therapy is still disputed. We have opted for it, on the basis of the obvious BSR increase and subfebrile temperatures.  

N/A  

1. Medline:
W.Grosch, W.Weigel, M.Gahr
Spondylodiszitis im Kindesalter
Monatsschr Kinderheilkd (1995)143:481-485

2. Medline:
A.H.Crawford, D.W. Kucharzyk, R.Ruda, H.C.Smitherman
Diskitis in children
Clin Orthop 266:70-79  

Spondylodiscitis, lumbar, L4/5 Spondylodiscitis, shooting pain, fall, elevated ESR, elevated CRP, vertebral disc inflammation, child, childhood, pediatric radiology  

Dirk Schaper, V Hofmann. Spondylodiscitis L4/5. PedRad [serial online] vol 3, no. 6.
URL: www.PedRad.info/?search=20030610135616