Laboratory testing plays a minor role Elevation of the WBC count is sometimes noted at the time of diagnosis ESRs of 40 to 60 mm/hr are usually noted in patients presenting with discitis and decrease with resolution of the disease Skin testing for tuberculosis, as well as serologic testing for brucellosis and salmonellosis, are often performed but not routinely recommended Discitis can usually be diagnosed and treated without biopsy or aspiration of the involved disc space About half of biopsy specimens in patients with discitis show evidence of bacterial infection A guided needle aspiration of the inflamed disc space can be helpful in therapeutic decision making Discitis is usually a self-limited disease and virtually all children in reported series return to normal function in a few months Resting the spine generally results in improved symptoms in days to weeks Immobilization with plaster has not been shown to improve outcome over bed rest alone, but therapeutic decisions should be individualized with input from an orthopedist FIGURE 121.17 Discitis L3–L4 intervertebral disc space is narrowed Lateral (A ) and anteroposterior (B ) views Although data from controlled trials are lacking given the rarity of this condition, antibiotics with antistaphylococcal activity seem prudent The