The aim of the study was to review the role of Magnetic Resonance Imaging of the spine in discitis in the toddler age group (one to three years).

Discitis presents differently in different age groups of children. It is most difficult to diagnose in the uncommunicative non-compliant toddler. The clinical features are often non-specific and laboratory and microbiological tests can be unhelpful. A highly sensitive test is required to aid in making the diagnosis. Although MR Imaging has been used in discitis for several years, we reviewed its actual effectiveness in this specific difficult age group.

At a mean of 21 months at follow-up (range 10 to 40), MR imaging of the disc was variable, with partial recovery after 15 months and complete recovery after 34 months. Routine follow-up MR imaging was not recommended.

We reviewed the role of Magnetic Resonance Imaging in eleven consecutive cases, both at presentation and at a follow-up clinic.

MR imaging was diagnostic in all cases, reduced the diagnostic delay, and often avoided a disc biopsy. It demonstrated any paravertebral inflammatory collection, which helped in determining the duration of the oral therapy given after the initial intravenous antibiotics.

Discitis is uncommon in children and presents in different ways at different ages. It is most difficult to diagnose in the uncommunicative toddler of one to three years of age. We present 11 consecutive cases. The non-specific clinical features included refusal to walk (63%), back pain (27%), inability to flex the lower back (50%) and a loss of lumbar lordosis (40%). Laboratory tests were unhelpful and cultures of blood and disc tissue were negative.

MRI reduces the diagnostic delay and may help to avoid the requirement for a biopsy. In 75% of cases it demonstrated a paravertebral inflammatory mass, which helped to determine the duration of the oral therapy given after initial intravenous antibiotics.

At a mean follow-up of 21 months (10 to 40), all the spines were mobile and the patients free from pain. Radiological fusion occurred in 20% and was predictable after two years. At follow-up, MRI showed variable appearances: changes in the vertebral body usually resolved at 24 months and recovery of the disc was seen after 34 months.