Common pathogens encountered in children include Staphylococcus aureus, Kingella kingae, pneumococci, and salmonella species The prevailing hypotheses are that it is thought to arise from a prior site of infection and spread via three possible routes: hematogenously, by direct inoculation, or by direct extension Almost 50% of children will have a prior prodromal illness related to their disc space infection In children, blood vessels are present in the annulus fibrosus and the vessels within the vertebral body typically are anastomotic These anatomic variations have been proposed as a reason explaining preferential localization of bacterial infections to the intervertebral disc space Spondylodiscitis in children has a bimodal age distribution (0 to years and >10 years) mostly affecting the thoracic and lumbar spine Diagnosis can often be delayed up to to months secondary to the low incidence and vague presentation in children Clinical Recognition Children most commonly present with back pain, but nonspecific symptoms may be the only presentation, often without fevers Very young children with discitis often may refuse to walk, regress with ambulatory motor skills, display Gower sign, torticollis or refuse to sit Several authors have proposed categories of symptoms for children presenting with discitis: back pain, hip and leg pain, meningeal symptoms, abdominal symptoms, or “irritable child” syndrome Diagnostic Testing and Imaging Laboratory values (CBC, ESR, CRP) and blood cultures should be obtained, but are often normal or only mildly elevated Blood cultures will often be positive early in the course of the illness but given the delay in diagnosis, often only 50% are diagnostic Very early in the course, plain radiographs may be negative as it typically takes weeks to a month before disc space narrowing becomes apparent Initial evaluation should include an MRI of the entire spine with contrast Technetium-99, bone scans will identify the problem to 12 days after onset of symptoms, but are nonspecific and require distinction between inflammatory and neoplastic etiology Management Treatment is controversial as most spondylodiscitis infections have a relatively benign course If a pathogen is not identified, a CT-guided biopsy should be considered prior to initiation of antibiotic treatment unless clinically contraindicated in the unstable or critically ill patient More routinely however, a course of intravenous broad-spectrum antibiotics followed by oral antibiotics for to weeks is prescribed