Diskitis

Alternative names
Disk inflammation

Definition
Diskitis is an inflammation, irritation, and swelling of the intervertebral disk space (the space between the bones of the spine).

Causes, incidence, and risk factors

This is an uncommon condition usually seen in children less than 10 years old.

Diskitis can be caused by a bacterial or viral infection or other inflammatory processes, such as auto-immune diseases (conditions in which the immune system mistakenly attacks certain cells in the body). The thoracic (upper back) and lumbar (low back) disks are most commonly affected.

Affected children may have a low-grade fever (less than 102 degrees Fahrenheit), back pain and stiffness, and abdominal pain. If they walk, it is with increased curvature of the back and they may have difficulty getting up and standing.

Young children are generally irritable and uncomfortable and may refuse to sit up, stand or walk. The refusal to walk is often misinterpreted by the parents as being related to a lower limb injury. Diskitis can also be confused with problems related to hip pain.

Symptoms

     
  • Fever  
  • Irritability  
  • Back pain  
  • Stiffness in back  
  • Increased lordosis  
  • Refusal to walk (younger child)  
  • Abdominal pain

Signs and tests

     
  • X-ray of the lumbosacral spine (may show narrow disk space or abnormalities of the vertebral bodies)  
  • MRI of the spine (may show inflammation of the disk space)  
  • Bone scan (usually shows increased uptake in the region of inflammation)  
  • CBC (shows elevated white blood cells)  
  • ESR (elevated, test for inflammation)

Treatment

The goal is to treat the cause of the inflammation and reduce pain. Anti-staphylococcal antibiotics may be given in cases of suspected infections. Auto-immune diseases are often treated with anti-inflammatory medications.

Resistent cases may be treated with steroids, although the diagnosis of infection should be excluded first. Pain may be relieved with oral pain killers (analgesics) or nonsteroidal anti-inflammatory drugs (NSAIDS); consult your health care provider for the best choice of medications.

Bed rest or immobilization (which may require a body cast) may be recommended in some cases.

Expectations (prognosis)

With infectious causes, full recovery following treatment is expected and chronic back pain related to this condition is very rare. For auto-immune causes, the outcome depends on the particular condition, but these are often chronic illnesses.

Complications

     
  • Persistent back pain (rare)  
  • Side effects of medications

Calling your health care provider

Call your health care provider if your child has persistent back pain or problems with standing and walking that seem unusual for his or her age.

Johns Hopkins patient information

Last revised: December 2, 2012
by Arthur A. Poghosian, M.D.

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