DIAGNOSIS/TREATMENT
■ ESRis almost always elevated.
■ Obtain immediate MRI to confirm diagnosis.
■ If MRI unavailable, a CT myelogram should be obtained.
■ Antibiotics: Vancomycin and third generation cephalosporin
■ Immediate surgical intervention
Diskitis
Diskitis is an inflammatory process of the intervertebral disc space, often due
to viral or bacterial (Staphylococcus aureus)infection. It is usually seen in
children under the age of 10. Risk factors include spinal surgical procedures,
systemic infections (eg, UTI), and immunocompromise.
SYMPTOMS/EXAM
■ Moderate to severe local pain and radicular symptoms
■ Children often present with sudden onset of back pain and refusal to walk
■ Fever (in most)
■ Neurologic deficits are uncommon
DIAGNOSIS/TREATMENT
■ MRI
■ Intravenous antibiotics
Spinal Neoplasm
Most commonly due to metastasis or direct spread from lung cancer, breast
cancer and lymphoma
SYMPTOMS/EXAM
■ Symptoms commonly localized to thoracic spine
■ Characterized by pain that is worse at night
DIAGNOSIS
■ Plain X-rays are abnormal in most patients.
■ MRI is confirmative.
TREATMENT
Includes high-dose steroids, radiation and surgery, depending on suspected
pathology and degree of compression
Transverse Myelitis
Spinal cord dysfunction due to viral infection, autoimmune or idiopathic
cause
SYMPTOMS/EXAM
■ Characterized by a transverse level of sensory impairment, paraplegia and
sphincter disturbance
NEUROLOGYAn elevated ESR/CRP in the
patient with unexplained back
pain should raise concern for
spinal epidural abscess.