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)(2001)(2002)(2003)(2004)(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.

Atypical Findings on Magnetic Resonance Imaging in the Patients with Active Pyogenic Spondylitis in Japanese University Hospitals

“…Typically, the onset of pyogenic spondylitis is characterized by back pain accompanied by fever (Tsiodras and Falagas 2006;Fantoni et al 2012). However, the insidious type of onset has become more common in Japan recently, reported between 16% and 65% (Ozawa 2008;Yoshimoto et al 2011). In the present study, about one-fourth of the patients showed this type of onset.…”

“…The onset type was classified using the modified Kulowski's classification (1936): 1) acute: onset with typical acute inflammatory symptoms such as high fever, severe back pain, and stiffness of the spinal column; 2) subacute: onset with slight fever and back pain; 3) insidious: unknown time of onset with only mild local symptoms such as back pain continuing for a certain period, without accompanying fever (Ozawa 2008;Yoshimoto et al 2011); and 4) unclassified.…”

“…The recent shift in demographics in Japan including an aging population, an increase in the number of patients with chronic debilitating disorders (immuno-compromised hosts), and the development and widespread use of immuno-suppressive agents might have affected the change in the clinical features of pyogenic spondylitis (Yoshimoto et al 2011;Fukuda et al 2012). For example, pyogenic spondylitis was once most frequently observed in adolescents to middle-aged individuals; however, it is currently most prevalent in the elderly (Yoshimoto et al 2011).…”

“…For example, pyogenic spondylitis was once most frequently observed in adolescents to middle-aged individuals; however, it is currently most prevalent in the elderly (Yoshimoto et al 2011). A decline in the acute-onset type, which is marked by high fever and severe back pain, and an increase in the insidiousonset type, where the exact time of onset is unknown, have been noted (Kulowski 1936;Ozawa 2008).…”

Failure modes in conservative and surgical management of infectious spondylodiscitis

“…Furthermore, minimally invasive and endoscopic surgeries are being promoted [9,11]. Treatment of infectious spondylodiscitis in children, geriatric patients, and patients with multiple risk factors can be very challenging and gives cause for intense discussions [10,13,19].…”