Anterior disc protrusion as a cause for abdominal symptoms in childhood discitis. A case report.
METHODS
A case report on infectious spondylitis in a child who reported abdominal pain and whose magnetic resonance image revealed anterior herniation of disc space contents.


OBJECTIVE
To correlate the direction of disc protrusion in infectious spondylitis with clinical manifestations.


BACKGROUND
Previous studies have correlated posterior protrusion of disc space contents in infectious spondylitis with a clinical presentation of back pain, paravertebral muscle spasm, hamstrings tightness, and radiculopathy. None has connected anterior herniation of disc phlegmon with abdominal pain.


METHODS
In addition to plain radiography and bone scintigraphy, magnetic resonance imaging was used to confirm the diagnosis of infectious spondylitis in a 6-year-old child with abdominal pain. Regular review for 1 year included repeat magnetic resonance imaging at 3 months.


RESULTS
Initial magnetic resonance imaging revealed characteristic changes associated with infectious spondylitis throughout the L5-S1 vertebra-disc-vertebra unit and anterior protrusion of the disc material and phlegmon. Magnetic resonance imaging at follow-up examination 3 months later demonstrated complete resolution of the disc herniation.


CONCLUSIONS
Future magnetic resonance imaging studies should correlate direction of disc herniation with age and symptomatology to validate or improve classifications of infectious spondylitis, which presently include only the last two parameters.
D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D000698:Analgesia; D000900:Anti-Bacterial Agents; D001510:Bed Rest; D002648:Child; D015299:Discitis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D008159:Lumbar Vertebrae / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D011877:Radionuclide Imaging; D012447:Sacrum / Q000000981:diagnostic imaging / Q000473:pathology