A narrative review of our developing knowledge about paediatric spondylodiscitis based on existing literature

Paediatric spondylodiscitis (SD) is an infection involving the vertebral bodies and adjacent intervertebral discs in populations below 16 years old. It is rarely confined to a single compartment; more often, it spreads to other areas in the spinal column and may cause other infections, such as epidural abscesses, subdural abscesses, septic arthritis of the facet joints, paravertebral abscesses and even meningitis. SD predominantly affects children from 6 to 48 months old, and the lumbar spine seems to be most at risk; no specific markers are currently available for a biological diagnosis of SD. Blood cultures are often negative, and even disc or bone biopsies show limited yields. However, recent advances in nucleic acid amplification tests have laid the foundations for developing and implementing more efficient methods of identifying pathogens in samples. Microbiologically, Kingella kingae dominates in children from 6 to 48 months old, while Staphylococcus aureus is more common in infants under 6 months and in older children. High-throughput sequencing performed on plasma samples (recognised as liquid biopsy) is a promising multi-purpose tool that can detect not only pathogens circulating in the bloodstream but also those emanating from focal infections, something particularly interesting in cases of paediatric SD, where disc sampling is strongly discouraged. Paediatric SD treatments are mainly medical; surgery is rarely indicated, except for abscess drainage, emergency neurological decompression or spinal stabilisation.