Pyogenic spondylitis in the elderly: a report from Japan with the most aging society

Abstract

Pyogenic spondylitis can be life-threatening for elderly patients. To discuss the characteristics of the disease in the elderly, medical records of 103 consecutive cases of pyogenic spondylitis were reviewed. Of these, 45 cases were 65 years of age or older, and these 45 cases were enrolled into further study. In this study, the proportion of elderly patients among the total number with pyogenic spondylitis was 43.7%, and this figure has increased with the passing of time as follows: 37.5% (1988-1993), 44.4% (1994-1999), and 55.5% (2000-2005). The microorganisms were isolated in 16 cases: Staphylococcus aureus in 13 cases (including methicillin-resistant Staphylococcus aureus in nine) and others in three. Twenty-five patients had associated diseases: diabetes in 18 patients and malignant tumors in seven. Thirty patients were treated conservatively, and 15 patients underwent surgery. Twenty-six patients had paralysis. All 15 patients treated surgically, and eight of the 11 patients treated conservatively showed improvement in paralysis. Bone union was achieved in all cases except one. Our results indicate that a good outcome can be expected from conservative treatment in elderly patients as well as the young.

Fig. 1

Case 1. A 70-year-old woman developed L1–L2 pyogenic spondylitis. She underwent radical excision of the lesion followed by anterior fusion with autologous iliac bone graft with posterior instrumentation, compression–distraction rod system [7]. Pre-operative antero-posterior (a) and lateral (b) radiographs show destruction of L1–L2 end-plates. Pre-operative magnetic resonance images show low intensity zone in the disk space in T1-weighted image (c) and high intensity zone in T2-weighted image (d). Antero-posterior (e) and lateral (f) radiographs taken 6 months after surgery show fusion of the vertebral bodies

Fig. 2

Improvement of paralysis in patients treated surgically (a) and conservatively (b)

Fig. 3

Case 2. A 82-year-old man developed an L4–L5 pyogenic spondylitis. He had severe pain and numbness in his right leg. Pre-treatment T1- (a) and T2 (b) -weighted magnetic resonance images show epidural abscess. He was treated conservatively, including immobilization of the spine by a hard corset and administration of antibiotics, and the pain in his leg disappeared. T1- (c) and T2 (d) -weighted magnetic resonance images taken 3 months later reveal disappearance of epidural abscess