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The clinical distinction between discitis and vertebral osteomyelitis may be difficult or impossible. Data from 50 children treated at the children's hospital in Houston, Texas between 1980 and 1998 have been reviewed (Marisol Fernandez and colleagues. Pediatrics2000;105: 1299–304). Of the 50 children, 36 had discitis and 14 vertebral osteomyelitis. Children with discitis were often younger (mean age 2.8 years, range 0.7–16 years) than those with osteomyelitis (mean 7.5 years, range 2–13 years) and had had symptoms for a shorter time (22 daysv 33 days). In both groups the usual symptoms were refusal to walk, limp, or back pain but those with osteomyelitis often appeared more ill and were more often febrile (79%v 28%). These authors dismiss radionucleotide bone scans and computed tomography as providing non-specific information and concentrate on plain radiography and magnetic resonance imaging. Plain x rays of the spine were performed on 33 patients with discitis and were regarded as diagnostic in 25 (76%). Ten children with discitis had MRI which showed abnormalities “consistent with the diagnosis” in nine. Of the 14 children with vertebral osteomyelitis plainx rays of spine were obtained in 13 and were normal in six. Eleven had MRI which established the diagnosis in all of them. These authors conclude that spinalx rays are diagnostic in most children with discitis but MRI is needed when vertebral osteomyelitis is a serious possibility.