Conservative Treatment of Pyogenic Spondylitis in the Elderly (고령 환자에서의 화농성 척추염의 보존적 치료)

Dong-Geun Kang (강동근); Jeong Soon-Taek (정순택); KIM DONG HEE (김동희); Park Hyung Bin (박형빈); 문종욱

Conservative Treatment of Pyogenic Spondylitis in the Elderly

Journal of Korean Society of Spine Surgery
Abbr : J Kor Spine Sur
2017, 24(1), pp.7-15
Publisher : Korean Society Of Spine Surgery
Research Area : Medicine and Pharmacy > Orthopedic Surgery

Dong-Geun Kang ¹, Jeong Soon-Taek ¹, KIM DONG HEE ¹, Park Hyung Bin ¹, 문종욱 ²

¹경상대학교
²경상대학교 창원병원 정형외과학교실

Accredited

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

Citation status

* References for papers published after 2023 are currently being built.

[journal] Skaf GS / 2010 / Pyogenic spondylodiscitis : an overview / J Infect Public Health 3 : 5~16

[journal] Govender S / 2005 / Spinal infections / J Bone Joint Surg Br 87 : 1454~1458

[journal] Lestini WF / 1994 / Lumbar spinal fusion : advantages of posterior lumbar interbody fusion / Surg Technol Int 3 : 577~590

[journal] Torda AJ / 1995 / Pyogenic vertebral osteomyelitis : analysis of 20 cases and review / Clin Infect Dis 20 : 320~328

[journal] Thelander U / 1992 / Quantitation of C-reactive protein levels and erythrocyte sedimentation rate after spinal surgery / Spine (Phila Pa 1976) 17 : 400~404

[journal] Yoshimoto M / 2011 / Pyogenic spondylitis in the elderly : a report from Japan with the most aging society / Eur Spine J 20 : 649~654

[journal] Bettini N / 2009 / Evaluation of conservative treatment of non specific spondylodiscitis / Eur Spine J 18(Suppl) : 143~150

[journal] Butler JS / 2006 / Nontuberculous pyogenic spinal infection in adults : a 12-year experience from a tertiary referral center / Spine (Phila Pa 1976) 31 : 2695~2700

[journal] Ozuna RM / 1996 / Pyogenic vertebral osteomyelitis and postsurgical disc space infections / Orthop Clin North Am 27 : 87~94

[journal] Buranapanitkit B / 2001 / Clinical manifestation of tuberculous and pyogenic spine infection / J Med Assoc Thai 84 : 1522~1526

[journal] Mylona E / 2009 / Pyogenic vertebral osteomyelitis : a systematic review of clinical characteristics / Semin Arthritis Rheum 39 : 10~17

[journal] Oostveen JC / 2000 / Magnetic resonance imaging in rheumatic disorders of the spine and sacroiliac joints / Semin Arthritis Rheum 30 : 52~69

[journal] Carragee EJ / 1997 / Pyogenic vertebral osteomyelitis / J Bone Joint Surg Am 79 : 874~880

[journal] Dagirmanjian A / 1999 / MR imaging of spinal infections / Magn Reson Imaging Clin N Am 7 : 525~538

[journal] Sharif HS / 1992 / Role of MR imaging in the management of spinal infections / AJR Am J Roentgenol 158 : 1333~1345

[journal] Luzzati R / 2009 / Diagnosis, management and outcome of clinically-suspected spinal infection / J Infect 58 : 259~265

[journal] Grados F / 2007 / Suggestions for managing pyogenic(non-tuberculous)discitis in adults / Joint Bone Spine 74 : 133~139

[journal] Hadjipavlou AG / 2004 / Percutaneous transpedicular discectomy and drainage in pyogenic spondylodiscitis / Eur Spine J 13 : 707~713

[journal] Rath SA / 1996 / Neurosurgical management of thoracic and lumbar vertebral osteomyelitis and discitis in adults : a review of 43 consecutive surgically treated patients / Neurosurgery 38 : 926~933

[journal] Roblot F / 2007 / Optimal duration of antibiotic therapy in vertebral osteomyelitis / Semin Arthritis Rheum 36 : 269~277

[journal] Sapico FL / 1996 / Microbiology and antimicrobial therapy of spinal infections / Orthop Clin North Am 27 : 9~13

[journal] Eismont FJ / 1983 / Pyogenic and fungal vertebral osteomyelitis with paralysis / J Bone Joint Surg Am 65 : 19~29

[journal] Perronne C / 1994 / Pyogenic and tuberculous spondylodiskitis(vertebral osteomyelitis)in 80 adult patients / Clin Infect Dis 19 : 746~750

[journal] Tsiodras S / 2006 / Clinical assessment and medical treatment of spine infections / Clin Orthop Relat Res 444 : 38~50

[journal] Acosta FL, Jr / 2006 / Recent advances : infections of the spine / Curr Infect Dis Rep 8 : 390~393

[journal] Quinones-Hinojosa A / 2004 / General principles in the medical and surgical management of spinal infections: a multidisciplinary approach / Neurosurg Focus 17 : E1~

[journal] Pigrau C / 2005 / Spontaneous pyogenic vertebral osteomyelitis and endocarditis : incidence, risk factors, and outcome / Am J Med 118 : 1287~

[journal] Park W-W / 2001 / Posterior lumbar interbody fusion in the pyogenic discitis / J Korean Soc Spine Surg 8 : 39~45

[journal] Shin D-E / 2007 / Anterior debridement and strut graft with pedicle screw fixation for pyogenic spondylitis / Asian Spine J 1 : 91~97

[journal] 조병기 / 2010 / Management of Lumbar Pyogenic Spondylitis with Posterior Decompression and Interbody Fusion Using Transpedicular Screws / 대한정형외과학회지 / 대한정형외과학회 45(3) : 165~172

KJCKorea
Journal Central

Journal of Korean Society of Spine Surgery 2023 KCI Impact Factor : 0.03