A 20-month-old girl has intermittent irritability, refusal to walk, and low-grade fever for 10 days. She resists lumbar flexion. ESR is 45 mm/hr and CRP is mildly raised. Plain radiograph is unremarkable; MRI shows oedema and enhancement centred on the L4-L5 intervertebral disc with adjacent end plates. Blood culture is sterile. The most appropriate initial management is:

• A Urgent anterior debridement and fusion
• B Percutaneous disc biopsy before starting any treatment
• C Bed rest, immobilisation, and empirical intravenous antibiotics ✓
• D Observation alone without antibiotics

Explanation

This is childhood (benign) discitis, a low-grade infection of the disc in toddlers who present with limp, irritability, and refusal to flex the spine. It responds well to rest, immobilisation, and empirical antibiotics covering Staphylococcus aureus, and biopsy is reserved for failure to improve. Surgery is needed only for neurological deficit, abscess, or deformity. Observation without antibiotics risks progression in a febrile child.

Reference: Tachdjian's Pediatric Orthopaedics, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.