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Joseph Junewick, MD FACR
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Diskitis

Case Detail

Anatomy: Brain-Spine
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Infectious-Inflammatory
Created: over 7 years ago
Updated: over 7 years ago
Tags: PEDS
Modality/Study Types: MR
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History

2 year old with fever, back pain and elevated sedimentation rate.


Case Images


Diagnosis

Diskitis

Findings

MR – Sagittal T1, T2, and IR images show heterogeneous signal in the L5-S1 disk with enhancement on post-gadolinium T1 image.

Discussion

Diskitis is an inflammatory process of the intervertebral disk. Diskitis has a bimodal distribution with one peak occurring between 6 months and 4 years of age and a second peak between 10 to 14 years of age. The pathophysiology of diskitis is likely related normal vascularity of the immature disk; the vascularity regresses with age. The etiology is thought to be infectious.

Diskitis occurs typically in the lumbar region, most often at the L2–L3 and L3–L4 levels. Clinical presentation varies and signs and symptoms (fever, back pain, irritability, refusal to walk or sit up, leukocytosis, elevated ESR and elevated C-reactive protein) are often non-specific and non-localizing, making the diagnosis difficult. Less than half of patients demonstrate positive blood cultures or biopsy materials but when positive the infectious agent is almost always Staphylococcus aureus.

Radiography is normal early in the process with visible loss of disk space or endplate erosion often requiring 1-2 weeks. Bone scintigraphy may be positive by 1–2 days after the onset of symptoms, demonstrating increased uptake in the intervertebral bodies on each side of the disk involved. MR imaging is the study of choice. MR imaging findings include loss of the normal hyperintense signal intensity of the disk on T2-weighted images, narrowing or complete absence of the disk, and marrow edema in adjacdent vertebral bodies. There may be contrast enhancement of the disk and adjacent vertebral body. MR is also helpful in diagnosing disk extrusion and the formation of paraspinal and epidural abscesses.

Most patients become asymptomatic within 3 weeks following antibiotic treatment. Prompt treatment can prevent disk loss.

Reference

Rodriuez DP, Pousaint TY. Imaging of back pain in children. AJNR (2010); 31:787-802.



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