WHEN TO SEE A SPINE SPECIALIST

You should seek the advice of a spine specialist if neck or back pain persists for more than two weeks or if it is progressive in intensity and/or distribution. You should seek immediate healthcare attention if neck or back pain occurs as the result of an injury or if it is associated with serious illness and/or a high fever. Additional signs and symptoms which warrant prompt medical attention include:

• Neck or back pain associated with bowel and/or bladder dysfunction
• Neck or back pain associated with extremity weakness or difficulty with coordination
• Extremity numbness or muscle weakness
• Neck or back pain that is associated with impaired walking (gait) or difficulty with balance
• Numbness, tingling and/or muscle weakness associated with a back or neck injury

SCREENING AND DIAGNOSIS

Children who develop discitis usually do not have symptoms of systemic illness. They may not have a classic fever or an elevated white blood cell count. However, a test referred to as the erythrocyte sedimentation rate (ESR) is usually elevated.

Lateral radiographs of the involved area of the spine may reveal intervertertebral disc space narrowing with erosive changes of the vertebral end plates of the adjacent vertebrae. A nuclear bone scan may help localize a lesion which is difficult to identify through clinical examination. A bone scan may not become positive for a week after the onset of discitis. Some bone scans will present with a false negative result so a negative bone scan does not completely exclude the possibility of infectious discitis. Magnetic resonance imaging (MRI) is the most reliable early confirmatory imaging study. It is very helpful at discovering an active disc space infection if the region of the suspected lesion is narrowed down to a particular area of the spine.

PROGNOSIS

The prognosis for non-inflection disc inflammation is good. The prognosis for infectious discitis is good if it is identified and treated early.

COMPLICATIONS

The complications of infectious discitis include systemic infection and spread locally to other spinal tissues. It could lead to the development of meningitis. Local complications include osteomyelitis within the adjacent vertebrae. The disc and the adjacent endplate may be injured, initiating a degenerative process which could compromise normal disc function at the involved level.