Emergent Care / Stabilization:
Urgent referral to orthopedics is recommended for immediate evaluation and intervention.

Causes / typical injury mechanism:

• Pediatric disk space infection is often caused by hematogenous spread of bacteria, commonly associated with systemic infections or conditions.
• Injury mechanisms include trauma, surgeries, or infections that may introduce pathogens into the vertebral disk space.

Classic history and presentation:

• Patients may present with back pain, refusal to move the spine secondary to pain, and localized tenderness.
• Fever, irritability, and neurologic symptoms can accompany the presentation, indicating potential disk space involvement.

Prevalence: Pediatric disk space infections are relatively rare – 0.3 cases per 100 000.

• Age – Occurs in individuals ages 20 years or younger due to residual vascular supply in the disk. There is a bimodal distribution of ages affected: 60% occurs between ages 6 months to 4 years and 40% occurs between ages 10-14 years.
• Sex / gender – Both sexes are affected, with only a slight predilection for males reported.

Risk factors: Immunocompromised states (HIV / AIDS, transplants, immunosuppressive treatment, chronic kidney disease, diabetes), preexisting spinal disease, recent infection, or invasive procedures increase the risk of developing pediatric disk space infections.

Pathophysiology:

• The causative pathogen is either directly inoculated into disk space (via trauma or invasive procedure) or through hematogenous spread from another site of infection.
• Most commonly occurs in the lumbar spine because of the rich vascular supply from the Batson venous plexus.
• The most common cause of pediatric disk space infection is Staphylococcus aureus.