Pediatric emergency medicine trisk 3977 3977
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Laboratory testing plays a minor role. Elevation of the WBC count is
sometimes noted at the time of diagnosis. ESRs of 40 to 60 mm/hr are usually
noted in patients presenting with discitis and decrease with resolution of the
disease. Skin testing for tuberculosis, as well as serologic testing for brucellosis
and salmonellosis, are often performed but not routinely recommended. Discitis
can usually be diagnosed and treated without biopsy or aspiration of the involved
disc space. About half of biopsy specimens in patients with discitis show
evidence of bacterial infection. A guided needle aspiration of the inflamed disc
space can be helpful in therapeutic decision making.
Discitis is usually a self-limited disease and virtually all children in reported
series return to normal function in a few months. Resting the spine generally
results in improved symptoms in days to weeks. Immobilization with plaster has
not been shown to improve outcome over bed rest alone, but therapeutic decisions
should be individualized with input from an orthopedist.
FIGURE 121.17 Discitis. L3–L4 intervertebral disc space is narrowed. Lateral (A ) and
anteroposterior (B ) views.
Although data from controlled trials are lacking given the rarity of this
condition, antibiotics with antistaphylococcal activity seem prudent. The
