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Spondylodiscitis in the elderly patient: clinical mid-term results and quality of life

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Focusing on spondylodiscitis in elderly patients current literature does not contain much information.

Method

We performed a retrospective case series (n = 32) comparing conservative (group 1; n = 16) versus operative (group 2; n = 16) treated spondylodiscitis patients aged ≥65 years (mean age 74.9 years) from January 2002 to April 2004. The review of the medical records provided information about the pre-hospital time, the inpatient course and the time after discharge. At follow-up (FU) (mean 3.6 years) disease specific and general quality of life (QOL) questionnaires (COMI back patient self-assessment, ODI and SF-36) were administered.

Results

Altogether, 71.9% of the patients could be contacted; 12.5% had died since hospitalisation and 15.6% could not be contacted anymore. At FU based on the visual analogue scale, patients indicated an average of 3.2 for back pain and 2.5 for leg pain. ODI scoring yielded minimal disability for 38.9%, a moderate disability for 22.2%, a severe disability for 22.2% and for 11.1% a crippled situation; 5.6% were bed-ridden or exaggerated their symptoms. The SF-36 PCS amounted to an average of 38.2, the MCS 50.6. Owing to additional surgery-associated risks, operative treatment of spondylodiscitis feature a complication rate twice as high in the respective group, but general complications do not differ. At FU, no statistically remarkable difference concerning QOL and remaining pain became evident between the groups, the operated patients being more satisfied with regard to the treatment of spondylodiscitis.

Conclusion

Ultimately, if surgery is indicated the operative risks should be borne in mind, but advanced age should not be the crucial factor in decision-making.

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References

  1. Belzunegui J, Intxausti JJ, De Dios JR, del Val N, Figueroa M (2000) Haematogenous vertebral osteomyelitis caused by Staphylococcus epidermidis: report of 4 cases. Clin Exp Rheumatol 18(1):115–116

    CAS  PubMed  Google Scholar 

  2. Butler JS, Shelly MJ, Timlin M, Powderly WG, O’Byrne JM (2006) Nontuberculous pyogenic spinal infection in adults: a 12-year experience from a tertiary referral center. Spine 31(23):2695–2700

    Article  PubMed  Google Scholar 

  3. Cahill DW, Love LC, Rechtine GR (1991) Pyogenic osteomyelitis of the spine in the elderly. J Neurosurg 74(6):878–886

    Article  CAS  PubMed  Google Scholar 

  4. Carreon LY, Puno RM, Dimar JR, II, Glassman SD, Johnson JR (2003) Perioperative complications of posterior lumbar decompression and arthrodesis in older adults. J Bone Joint Surg 85-A(11):2089–2092

  5. Daubs MD, Lenke LG, Cheh G, Stobbs G, Bridwell KH (2007) Adult spinal deformity surgery: complications and outcomes in patients over age 60. Spine 32(20):2238–2244

    Article  PubMed  Google Scholar 

  6. Deyo RA, Cherkin DC, Loeser JD, Bigos SJ, Ciol MA (1992) Morbidity and mortality in association with operations on the lumbar spine: the influence of age, diagnosis, and procedure. J Bone Joint Surg 74(4):536–543

    CAS  PubMed  Google Scholar 

  7. Deyo RA, Mirza SK (2006) Trends and variations in the use of spine surgery. Clin Orthop Relat Res 443:139–146

    Article  PubMed  Google Scholar 

  8. Eysel P, Hopf C, Vogel I, Rompe JD (1997) Primary stable anterior instrumentation or dorsoventral spondylodesis in spondylodiscitis? Results of a comparative study. Eur Spine J 6(3):152–157

    Article  CAS  PubMed  Google Scholar 

  9. Frangen TM, Kalicke T, Gottwald M et al (2006) Surgical management of spondylodiscitis: an analysis of 78 cases. Der Unfallchirurg 109(9):743–753

    Article  CAS  PubMed  Google Scholar 

  10. Fraser RD, Osti OL, Vernon-Roberts B (1987) Discitis after discography. J Bone Joint Surg Br 69(1):26–35

    CAS  PubMed  Google Scholar 

  11. Grados F, Lescure FX, Senneville E, Flipo RM, Schmit JL, Fardellone P (2007) Suggestions for managing pyogenic (non-tuberculous) discitis in adults. Joint Bone Spine 74(2):133–139

    Article  PubMed  Google Scholar 

  12. Hodgson AR, Stock FE, Fang HS, Ong GB (1960) Anterior spinal fusion: the operative approach and pathological findings in 412 patients with Pott’s disease of the spine. Br J Surg 48:172–178

    Article  CAS  PubMed  Google Scholar 

  13. Jensen AG, Espersen F, Skinhoj P, Frimodt-Moller N (1998) Bacteremic Staphylococcus aureus spondylitis. Arch Intern Med 158(5):509–517

    Article  CAS  PubMed  Google Scholar 

  14. Lindholm TS, Pylkkanen P (1982) Discitis following removal of intervertebral disc. Spine (Phila Pa 1976) 7(6):618–622

  15. Linhardt O, Matussek J, Refior HJ, Krodel A (2007) Long-term results of ventro-dorsal versus ventral instrumentation fusion in the treatment of spondylitis. Int Orthop 31(1):113–119

    Article  CAS  PubMed  Google Scholar 

  16. Mader JT, Shirtliff ME, Bergquist S, Calhoun JH (2000) Bone and joint infections in the elderly: practical treatment guidelines. Drugs Aging 16(1):67–80

    Article  CAS  PubMed  Google Scholar 

  17. Maiuri F, Iaconetta G, Gallicchio B, Manto A, Briganti F (1997) Spondylodiscitis clinical and magnetic resonance diagnosis. Spine 22(15):1741–1746

    Article  CAS  PubMed  Google Scholar 

  18. Mannion AF, Elfering A, Staerkle R et al (2005) Outcome assessment in low back pain: how low can you go? Eur Spine J 14(10):1014–1026

    Article  PubMed  Google Scholar 

  19. McHenry MC, Easley KA, Locker GA (2002) Vertebral osteomyelitis: long-term outcome for 253 patients from 7 Cleveland-area hospitals. Clin Infect Dis 34(10):1342–1350

    Article  PubMed  Google Scholar 

  20. Muckley T, Schutz T, Schmidt MH, Potulski M, Buhren V, Beisse R (2004) The role of thoracoscopic spinal surgery in the management of pyogenic vertebral osteomyelitis. Spine 29(11):E227–E233

    Article  PubMed  Google Scholar 

  21. Nolla JM, Ariza J, Gomez-Vaquero C et al (2002) Spontaneous pyogenic vertebral osteomyelitis in nondrug users. Semin Arthritis Rheum 31(4):271–278

    Article  PubMed  Google Scholar 

  22. Osti OL, Fraser RD, Vernon-Roberts B (1990) Discitis after discography: the role of prophylactic antibiotics. J Bone Joint Surg Br 72(2):271–274

    CAS  PubMed  Google Scholar 

  23. Raffo CS, Lauerman WC (2006) Predicting morbidity and mortality of lumbar spine arthrodesis in patients in their ninth decade. Spine 31(1):99–103

    Article  PubMed  Google Scholar 

  24. Ragab AA, Fye MA, Bohlman HH (2003) Surgery of the lumbar spine for spinal stenosis in 118 patients 70 years of age or older. Spine 28(4):348–353

    Article  PubMed  Google Scholar 

  25. Roder C, Chavanne A, Mannion AF, Grob D, Aebi M (2005) SSE spine tango–content, workflow, set-up. www.eurospine.org-Spine Tango. Eur Spine J 14(10):920–924

    Article  CAS  PubMed  Google Scholar 

  26. Schinkel C, Gottwald M, Andress HJ (2003) Surgical treatment of spondylodiscitis. Surg Inf 4(4):387–391

    Article  Google Scholar 

  27. Shabat S, Arinzon Z, Folman Y et al (2008) Long-term outcome of decompressive surgery for lumbar spinal stenosis in octogenarians. Eur Spine J 17(2):193–198

    Article  PubMed  Google Scholar 

  28. Sobottke (2008) Spondylitis and spondylodiscitis. In: C.B. Käfer W, Mattes T, Reichel H (ed) Orthopaedic spine surgery. Steinkopff

  29. Sobottke R, Csecsei G, Kaulhausen T et al (2008) Spinal surgery in the elderly: does age have an influence on the complication rate? Der Orthopade 37(4):367–373

    Article  CAS  PubMed  Google Scholar 

  30. SH Sobottke R, Fätkenheuer G, Schmidt M, Goßmann A, Eysel P (2008) Current diagnosis and treatment of spondylodiscitis. Dtsch Arztebl Int 105(10):181–188

    Google Scholar 

  31. Sobottke R, Zarghooni K, Seifert H et al (2008) Spondylodiscitis caused by Mycobacterium xenopi. Arch Orthop Trauma Surg 128(10):1047–1053

    Article  CAS  PubMed  Google Scholar 

  32. Uchida K, Nakajima H, Yayama T, et al. (2009) Epidural abscess associated with pyogenic spondylodiscitis of the lumbar spine; evaluation of a new MRI staging classification and imaging findings as indicators of surgical management: a retrospective study of 37 patients. Arch Orthop Trauma Surg [Epub ahead of print]

  33. Woertgen C, Rothoerl RD, Englert C, Neumann C (2006) Pyogenic spinal infections and outcome according to the 36-item short form health survey. J Neurosurg Spine 4(6):441–446

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

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Authors and Affiliations

  1. Department of Orthopaedic and Trauma Surgery, University of Cologne, Joseph-Stelzmann-Str. 9, 50924, Cologne, Germany

    Rolf Sobottke, Marc Röllinghoff, Keta Zarghooni, Kourosh Zarghooni, Klaus Schlüter-Brust, Karl-Stefan Delank & Peer Eysel

  2. Department of Microbiology, Immunology, Hygiene, University of Cologne, Goldenfelsstr. 19-21, 50935, Cologne, Germany

    Harald Seifert

  3. Institute for Evaluative Research in Orthopaedic Surgery, University of Bern, Stauffacherstraße 78, 3014, Bern, Switzerland

    Thomas Zweig

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  1. Rolf Sobottke
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Correspondence to Rolf Sobottke.

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Sobottke, R., Röllinghoff, M., Zarghooni, K. et al. Spondylodiscitis in the elderly patient: clinical mid-term results and quality of life. Arch Orthop Trauma Surg 130, 1083–1091 (2010). https://doi.org/10.1007/s00402-009-0972-z

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  • DOI: https://doi.org/10.1007/s00402-009-0972-z

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