Article
Management of infectious spondylodiscitis in patients older than 65 years: risk factors, etiology, therapy strategies and outcome
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Published: | June 8, 2016 |
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Objective: The incidence of spondylodiscitis has increased in recent years, likely due to longer life expectancies, the increasing prevalence of chronic disease, improved diagnosis and more frequent use of indwelling intravascular catheters and immunosuppressive therapies. In this retrospective study we wanted to investigate the age related outcome of spondylodiscitis patients.
Method: We included 63 cases of consecutive, spontaneous infectious lumbar spondylodiscitis from a single primary medical centre, from January 2004 to June 2015. Patient demographics, presenting complaints, current chronic diseases and therapies, pre/post-treatment neurologic status (MRC 1-5), treatment (medical vs. surgical, timing of surgery), duration of hospital stay, and clinical follow-up were recorded.
Results: There were 45 male and 19 female with a mean age of 64.4 years. Patients were divided into two groups according to their age at the time of treatment as follows: group A < 65 years and group B > 65 years. 55 patients (87%) suffered at the time of clinical manifestation from one or more relevant chronic diseases. Patients in group A (< 65 years) had a significant (p 0.047) shorter hospital stay with 34.8 d than patients in group B (> 65 years) who had a significant longer stay with 47.1 d. Patients in both groups who were treated with an early dorsal lumbar fusion (< 10 d) showed no difference in hospital stay or outcome. Neurological deficit was found in 29 patients (group A 10; group B 19) with a recovery rate of 79 %. Both groups showed a substantial pain reduction at the end of treatment. Source of infection was found in 72 % of all patients.
Conclusions: In our investigation patients with lumbar spondylodiscitis older than 65 years had a significant longer hospital stay. But patients older than 65 years who received early dorsal fusion (< 10 d) had no difference in hospital stay or other outcome parameters compared to younger patients (< 65 years). These results suggest that early dorsal lumbar fusion is a useful and effective therapy in elderly patients with spondylodiscitis.