Conservative Treatment of Pyogenic Spondylitis in the Elderly

Dong-Geun Kang; Dong-Hee Kim; Hyung Bin Park; Jong-Uk Mun; Soon Taek Jeong

doi:10.4184/jkss.2017.24.1.7

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Kang, Kim, Park, Mun, and Jeong: Conservative Treatment of Pyogenic Spondylitis in the Elderly

Original Article

Journal of Korean Spine Surg 2017;24(1):7-15.

Published online: 31 March 2017

DOI: https://doi.org/10.4184/jkss.2017.24.1.7

Conservative Treatment of Pyogenic Spondylitis in the Elderly

Dong-Geun Kang, M.D.^∗, Dong-Hee Kim, M.D.^∗, Hyung Bin Park, M.D.^∗, Jong-Uk Mun, M.D.^†, Soon Taek Jeong, M.D.^∗,

^∗Department of Orthopedic Surgery, Gyeongsang National University School of Medicine, Jinju, Korea

^†Department of Orthopedic Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea

Corresponding author: Soon Taek Jeong, M.D., Ph.D. Department of Orthopedic Surgery, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, 15 Jinju-daero 816beon-gil, Jinju-si, Gyeongsangnam-do, Republic of Korea, 52727 TEL: +82-55-750-8101, FAX: +82-55-761-9477 E-mail: ssurgeon@gnu.ac.kr

Received 20 September 201622 September 2016 Accepted 6 December 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Spine, Pyogenic spondylitis, Old age, Conservative treatment

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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.

Table 1.

Clinical profiles of the patients who were detected on the causative microorganism

Case No.	Organism	Exploration	Sex	Age	Affected level	Duration of diagnosis (days)	No. of comorbid-ity	Fever	WBC	ESR	CRP	Epidural abscess	Psoas abscess	Type of IV antibiotics	Duration of IV antibiotics (days)
1	MSSA^∗	Blood culture	F	79	L4-S1	7	0	38.4	14550	26	18.6	(+)	(−)	cephalosporin	35
6	B. cepacia^†	Percutaneous aspiration	M	72	L1-3	5	2	37.9	10100	110	17.3	(+)	(+)	ciprofloxacin	36
14	MRSA^‡	Operation	F	74	L3-4	30	0	38.5	10760	82	97.2	(+)	(+)	vancomycin	37
17	S. mitis^§	Blood culture	F	67	L2-3	7	0	38.8	13180	120	231.5	(+)	(−)	penicillin	26
19	E.faecalis^∥	Percutaneous aspiration	M	72	L3-4	21	0	37.8	18040	104	67.1	(−)	(+)	cephalosporin	24
21	MRSA^‡	Operation	M	71	L1-5	12	1	39.6	19770	41	229.7	(+)	(+)	vancomycin	34
22	E.coli^¶	Blood culture	M	66	L2-3	30	0	37.5	13120	83	105.4	(+)	(−)	levofloxacin	20
23	S. epidermidis^∗∗	Operation	M	74	L4-5	21	0	36.9	12800	69	10.4	(+)	(−)	penicillin	33
24	MRSA^‡	Percutaneous aspiration	F	65	L1-2	9	0	38.2	16420	88	282.8	(−)	(+)	vancomycin	90
28	S. epidermidis^∗∗	Blood culture	F	70	L4-5	30	1	36.0	10700	111	140.2	(−)	(−)	cephalosporin	14
30	S. agalactiae^††	Blood culture	M	65	L3-5	6	1	38.7	5770	120	171.7	(−)	(+)	ampicillin + sulbactam	27
31	E.faecium	Blood culture	F	79	T12-L1	3	0	36.6	6820	69	72.3	(−)	(−)	cephalosporin	20

^∗ MSSA: Methicillin-sensitive Staphylococcus aureus

^† B. cepacia: Burkholderia cepacia

^‡ MRSA: Methicillin-resistant Staphylococcus aureus

^§ S. mitis: Streptococcus mitis

^∥ E.faecium: Enterococcus faecium

^¶ E. coli: Escherichia coli

^∗∗ S. epidermidis: Staphylococcus epidermidis

^†† S. agalactiae: Streptococcus agalactiae.

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