Abstract
Background: Pyogenic haematogenous spinal infection in the elderly, described as spondylodiscitis, vertebral osteomyelitis and epidural abscess is still considered a rare but life threatening condition.
Objective: To test our hypothesis that low index of suspicion leads to delayed diagnosis.
Late referral for definitive treatment may result in increased and perhaps avoidable medical morbidity, social and psychological drift, including early mortality.
Method: Retrospective review of medical records over 10-year period.
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Patient pool obtained from theatre records, radiology and coding departments.
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Post-spinal operative infections and patients under 65 years old excluded.
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Initial presentation, admitting speciality, initial investigations and differential diagnosis, time to diagnosis, date and day of referral, mode of definitive treatment, pathologic entities, complications and outcomes were noted.
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Patient outcomes were measured as duration of treatment, length of hospital stay, complications, ambulatory status, complications, discharge destination and death.
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Outcomes were correlated with delayed diagnosis and referral.
Results: Single largest series [n=46] of elderly [age> 65] patients with pyogenic spinal infections to our knowledge.
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Age ranged from 65–91 with mean of 71.
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62% referral from Physician colleagues.
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Fever with malaise associated with chronic LBP was the commonest presenting complaint.
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34 patients had discitis and 12 had epidural abscess.
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Time to diagnosis ranged from 2–17 days with mean of 8 days. Mean referral time to spinal team was 9 days with 39% referrals on Friday.
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Duration of hospital ranged from two weeks to three months.
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46% required surgical decompression with four cases of related mortality during acute hospital stay.
Conclusions: Time duration to Spinal referral had direct correlation with increase in morbidity, social and psychological drift, and mortality.
The incidence of haematogenous spinal infection in the elderly has increased over the years in our series, contrary to popular belief.
A high index of suspicion in elderly patients with PUO promotes early diagnosis and optimises outcome.
Correspondence should be addressed to Sue Woordward, Britspine Secretariat, 9 Linsdale Gardens, Gedling, Nottingham NG4 4GY, England. Email: sue.britspine@hotmail.com
