J Korean Soc Spine Surg.  2017 Mar;24(1):7-15. 10.4184/jkss.2017.24.1.7.

Conservative Treatment of Pyogenic Spondylitis in the Elderly

• Kang DG
• Kim DH
• Park HB
• Mun JU
• Jeong ST

• KMID: 2402837
• DOI: http://doi.org/10.4184/jkss.2017.24.1.7

Abstract

STUDY DESIGN: Retrospective study.
OBJECTIVES
To analyze the outcomes of conservative management in elderly patients over 65 years of age who were diagnosed with pyogenic spondylitis. SUMMARY OF LITERATURE REVIEW: The surgical treatment of pyogenic spondylitis can lead to complications in elderly patients in a poor general condition or with underlying diseases.
MATERIALS AND METHODS
We performed a retrospective review of 32 patients who were diagnosed with pyogenic spondylitis and had a minimum of 12 months of follow-up. Age, sex, comorbidities, clinical symptoms, and the involved segments were analyzed retrospectively. The diagnosis was assessed using clinical, laboratory, and radiologic findings. Antibiotic therapy was either specific (if positive culture results were found) or broad-spectrum cephalosporin (when the pathogenic agent was not isolated). Outcomes were assessed using residual pain and neurologic deficits.
RESULTS
The mean onset time was 23.5 days (range, 3-90 days). The mean period of intravenous antibiotic therapy was 36.3 days (range, 10-90 days). All cases underwent conservative management, and 4 patients with progressive neurologic deficits due to epidural abscess underwent posterior laminectomy and abscess drainage. In all cases, the infection was successfully treated, although 12 cases reported residual lower back pain and 2 continued to exhibit minor neurologic deficits.
CONCLUSIONS
In elderly patients with pyogenic spondylitis, satisfactory results were obtained with conservative management using antibiotics and orthosis after an early diagnosis, unless progressive neurologic symptom instability or spine deformities were noted.

Keyword

Spine; Pyogenic spondylitis; Old age; Conservative treatment

MeSH Terms

Abscess
Aged*
Anti-Bacterial Agents
Comorbidity
Congenital Abnormalities
Diagnosis
Drainage
Early Diagnosis
Epidural Abscess
Follow-Up Studies
Humans
Laminectomy
Low Back Pain
Neurologic Manifestations
Orthotic Devices
Retrospective Studies
Spine
Spondylitis*
Anti-Bacterial Agents

Figure

• 

  Fiu. 1. A 77-year-old woman developed L5-S1 pyogenic spondylitis with an epidural abscess. (A) Initial lumbar spine anteroposterior (AP) and lateral radiographs show end-plate destruction of L5 and S1. (B) Magnetic resonance imaging shows low-intensity signal changes in both sides of L5 and S1 in a T1-weighted image and enhancement in both sides of the L5 and S1 body between the disc space and epidural abscess in a T1-weighted enhanced image, while a T2-weighted image shows an increased signal change in the disc and epidural abscess. (C) Lumbar spine AP and lateral radiographs taken 12 months after conservative management demonstrate narrowing of the disc space.

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