Satoshi Sato, Yasuyo Kashiwagi, Hisashi Kawashima, Tasuku Miyajima, Kouji Takekuma, Akinori Hoshika
Department of Pediatrics, Tokyo Medical University

Spondylodiscitis (1, 2) is uncommon in infants. Clinical manifestations vary with age. Infants may present with irritability, toddlers may refuse to walk. MRI of the spine is diagnostic. It shows irregularity and destruction of the vertebral end plates and body, increased signal intensity on T2-weighted images, and bone destruction within adjacent vertebrae. Edema and purulent material in the marrow or disk space will appear as a dark signal on T1-weighted images and as a bright signal on T2-weighted images. CT was useful in providing a specific diagnosis of bone structure. CT scans also can identify the presence of adjacent soft tissue masses or abscesses. However, axial CT may miss destructive changes in spondylodiscitis. Reformatted CT sagittal images disclose spine damage much more obviously than axial slices alone.
Even though it is uncommon, the index of suspicion should be high in a child presenting with fever and refusal to sit or walk.

1. An HS, Seldomridge JA. Spinal Infections: Diagnostic Tests and Imaging Studies. Clin Orthop Relat Res. 2006;444:27-33.
2. Kayser R, Mahlfeld K, Greulich M, Grasshoff H. Spondylodiscitis in Childhood: Results of a Long-Term Study. Spine. 2005;30:318-23.

Last Updated and Advance Access: 1-9-2007 Vol 5 Issue 3 Art # 12

Sato S, Kashiwagi Y, Kawashima H, Miyajima T, Takekuma K, Hoshika A. Diagnosis of Spondylodiscitis by Magnetic Resonance Imaging And Computed Tomography. Pediatric Oncall [serial online] 2007 [cited 2007 September 1];5. Art # 12. Available from:
http://www.pediatriconcall.com/fordoctor/viewersChoice/spondylodisctis.asp