A 3-year-old child presents with refusal to walk, low-grade fever, and irritability for 5 days. Examination reveals mild lumbar tenderness. ESR is 60 mm/hr and CRP is elevated. Blood cultures are pending. MRI shows T2 hyperintensity in the L3 vertebral body and adjacent disc with mild enhancement. Which statement about this condition is correct?

• A Plain radiographs reliably exclude the diagnosis in the first 48 hours
• B It is most commonly caused by Streptococcus pneumoniae in this age group
• C It is the result of direct hematogenous seeding of the avascular intervertebral disc ✓
• D It typically requires surgical debridement and fusion

Explanation

Discitis in young children results from septic emboli to the persistent vascular channels in the cartilaginous endplates, which then spread to the avascular disc. Staphylococcus aureus is the most common organism, not pneumococcus. Plain radiographs are normal early and cannot reliably exclude discitis within 48 hours. Most cases respond to intravenous antibiotics and do not require surgery. Surgical intervention is reserved for neurological compromise or failure of conservative treatment.

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

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Written and medically reviewed by the StethoPrep medical team.