Background Infectious Spondylodiscitis is rare among elderly people. Besides being life-threatening it has variable clinical presentations and insidious onset, leading to a delay in diagnosis and a difficulty in treating
Objectives To analyse the characteristics of spondylodiscitis in the elderly patients focusing upon epidemiology, diagnosis, and treatment outcome.
Methods A retrospective monocentric study was performed. All patients with spondylodiscitis admitted between 1999 and 2013 at the rheumatology department of the Charles Nicolles Hospital, and aged more than sixty-five years were included. Demographic characteristics, underlying diseases, imaging studies, isolated microorganisms, different treatments, complications, and outcome were recorded.
Results Twenty two patients among seventy seven cases of spinal spondylodiscitis were more than sixty-five years old. Ten patients were male. Duration of symptoms before the diagnosis was 6.3 months (20 days-24 months). The presence of diabetes mellitus was found in five patients, underlying chronic comorbidities in three cases, high-dose ofcorticotherapy in one case and renal failure in one case. Inflammatory back pain was reported in 19 cases, stiffness in 14 cases, fever in only 5 cases with an average of 38.3°, impaired general condition in 16 cases and night sweat in 9 cases. Neurological involvement was found in 3 cases.
The vertebral level involved was lumbar in 15 patients, thoracic in 5 patients, in the thoracolumbar junction in 2 patients, sacral in one patient and cervical in one other. Multifocal spondylodiscitis was found in 6 cases. Radiographies have shown anomalies in all patients. MRI has shown epiduritis in 9 cases, abscess of psoas in 8 patients, paravertebral abscess in 5 cases and medullar compression in 2 cases.
Hyperleucocytose and leucopenia were noted in 4 cases each, whether increased erythrocyte sedimentation rate (ESR) were observed in all patients with a mean value of 96mm. The mean CRP was 70mg/l.
In our study, we found 8 cases of pyogenic spondylodiscitis and 14 cases of specific spondylodiscitis. Among pyogenic spondylodiscitis patients’, blood cultures identified the microorganism in three cases: Serratia Marcescens in one case, Lactococcus cremoris in one case and association of Staphylococcus and Enterobacter cloacae in the last case. In the other 5 casesdiagnosis was madeonclinical features and the results of the punction biopsy of the intervertebral disc (PBID).
Among specific spondylodiscitis, positive Wright serology yielded the diagnosis of brucellar spondylodiscitis in 3 cases, whether 11 cases of tuberculosis spondylodiscitis were confirmed by positive tuberculin skin test and specific lesions in the PBID.
During treatment, 5 patients experienced different complications: renal failure in one case, medullar compression in another case, relapse in two cases, and death in one case.
Conclusions Spondylodiscitis in elderly patients is characterized by a delayed diagnosis. A large spectrum of microorganism may be involved. In a significant number of cases, neurological impairment, relapse or fatal outcome may occur.
Disclosure of Interest None Declared
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