背景:脊椎盘炎(SD),一种儿童罕见的疾病,由于非特异性表现症状,构成了诊断挑战,发病率稀缺,难以表达非语言儿童的痛苦。
方法:对三个数据库进行了全面搜索,包括PubMed/Medline,WebofScience,和Scopus,直到2023年3月。纳入标准是调查临床特征的研究,治疗,和儿童脊椎盘炎的并发症。增加了横断面和队列研究的全文。使用纽卡斯尔-渥太华质量评估量表进行队列研究的质量评估。搜索,筛选,和数据提取由两名研究人员独立进行。
结果:儿童椎间盘炎的临床表现是非特异性的,如背痛,发烧,能力下降或无法行走或坐下,一瘸一拐的,减少运动范围。诊断时间的平均延迟为4.8周。所有研究中受影响最大的部位是腰椎。94%的研究报告炎症标志物增加,如白细胞计数,C反应蛋白,和红细胞沉降率。不到30%的患者有阳性的血培养和活检结果。最常见的微生物学结果(64%)是金黄色葡萄球菌和金氏金鸡。在射线照相评估中,椎间盘变窄,腰椎前凸缩小,磁盘高度损失,并且已经报道了椎体的破坏。在所有研究中,开始抗生素治疗;在52%的固定化中,29%的研究报告进行了手术,随访期从1.5个月到156个月不等。94%的研究报告了椎体破坏等并发症,背痛,后凸畸形,运动范围缩小,脊柱侧弯,和神经系统并发症。
结论:脊椎盘炎并不常见,异质,导致诊断困难和延迟的多因素疾病。由于其发病率,调查拒绝走路的儿童是至关重要的,步态紊乱,或者背痛,特别是当与炎症标志物升高相关时。
Spondylodiscitis (SD), a rare disease in children, poses diagnostic challenges due to non-specific presenting symptoms, scarcity in incidence, and difficulty expressing pain in non-verbal children.
A comprehensive search was conducted on three databases, including PubMed/Medline, Web of Science, and Scopus until March 2023. The inclusion criteria were studies that investigated the clinical characteristics, treatment, and complications of children\'s spondylodiscitis. Full text of cross-sectional and cohort studies were added. The quality assessment of cohort studies was conducted using the Newcastle-Ottawa Quality Assessment Scale. The search, screening, and data extraction were performed by two researchers independently.
Clinical manifestations of discitis in children are nonspecific, such as back pain, fever, reduced ability or inability to walk or sit, limping, and reduced range of movements. The mean delay in the time of diagnosis was 4.8 weeks. The most affected site of all the studies was the lumbar spine. 94% of studies reported increased inflammatory markers such as white blood cell count, C-reactive protein, and erythrocyte sedimentation rate. Less than 30% of patients had positive blood cultures and biopsy findings. The most common microbiological results (64%) were Staphylococcus Aureus and Kingella kingae. In radiographic evaluation, intervertebral disk narrowing, lumbar lordosis reduction, loss of disk height, and destruction of the vertebral body have been reported. In all studies, antibiotic therapy was initiated; in 52% immobilization was employed, and 29% of studies reported surgery was performed, and the follow-up period differed from 1.5 months to 156 months. 94% of studies reported complications such as vertebral body destruction, back pain, kyphosis, reduced range of movement, scoliosis, and neurological complications.
Spondylodiscitis is an uncommon, heterogeneous, multifactorial disease with resulting difficult and delayed diagnosis. Due to its morbidity, it is essential to investigate children with refusal to walk, gait disturbances, or back pain, particularly when associated with elevated inflammatory markers.