Spinal infections in older people: an analysis of demographics, presenting features, microbiology and outcomes

Amadoru, Sanka; Lim, Kyutae; Tacey, Mark; Aboltins, Craig

doi:10.1111/imj.13300

Cited by 20 publications

(16 citation statements)

References 27 publications

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“…In total, 14 out of 40 papers did not describe or adequately describe the radiological tests performed. This includes plain film radiography, ultrasound, magnetic resonance imaging scan (MRI), gallium scan, bone scan, computed tomography (CT) scan and myelogram [7, 13, 15, 39, 41–51]. MRI was the most used radiological test with 22 papers using it for investigation.…”

Section: Resultsmentioning

confidence: 99%

Red flags for the early detection of spinal infection in back pain patients

Yusuf

Finucane

Selfe

2019

BMC Musculoskelet Disord

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BackgroundRed flags are signs and symptoms that are possible indicators of serious spinal pathology. There is limited evidence or guidance on how red flags should be used in practice. Due to the lack of robust evidence for many red flags their use has been questioned. The aim was to conduct a systematic review specifically reporting on studies that evaluated the diagnostic accuracy of red flags for Spinal Infection in patients with low back pain.MethodsSearches were carried out to identify the literature from inception to March 2019. The databases searched were Medline, CINHAL Plus, Web of Science, Embase, Cochrane, Pedro, OpenGrey and Grey Literature Report. Two reviewers screened article texts, one reviewer extracted data and details of each study, a second reviewer independently checked a random sample of the data extracted.ResultsForty papers met the eligibility criteria. A total of 2224 cases of spinal infection were identified, of which 1385 (62%) were men and 773 (38%) were women mean age of 55 (± 8) years. In total there were 46 items, 23 determinants and 23 clinical features. Spinal pain (72%) and fever (55%) were the most common clinical features, Diabetes (18%) and IV drug use (9%) were the most occurring determinants. MRI was the most used radiological test and Staphylococcus aureus (27%), Mycobacterium tuberculosis (12%) were the most common microorganisms detected in cases.ConclusionThe current evidence surrounding red flags for spinal infection remains small, it was not possible to assess the diagnostic accuracy of red flags for spinal infection, as such, a descriptive review reporting the characteristics of those presenting with spinal infection was carried out. In our review, spinal infection was common in those who had conditions associated with immunosuppression. Additionally, the most frequently reported clinical feature was the classic triad of spinal pain, fever and neurological dysfunction.This is an Open Access article distributed in accordance with the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Section: Resultsmentioning

confidence: 99%

Red flags for the early detection of spinal infection in back pain patients

Yusuf

Finucane

Selfe

2019

BMC Musculoskelet Disord

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“…Subacute spondylodiscitis, a relatively uncommon clinical scenario, is becoming more common because of aging and higher incidence of bacteremia and sepsis episodes following use of invasive diagnostic and treatment methods [13,21]. The onset of symptoms usually is insidious, with persistent back or neck pain being the most common presenting complaint [6,7].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Challenges in Diagnosis of Spontaneous Subacute Pyogenic Spondylodiscitis in Immunocompetent Patients: Experiences from a Tertiary Care Center

et al. 2019

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Study Design Prospective clinical study. Purpose We evaluated the challenges faced during diagnosis and management of patients with subacute pyogenic discitis and discussed various clues in clinical history, radiologic and hematologic parameters of these patients that helped in establishing their diagnosis. Overview of Literature Present literature available shows that in patients with subacute spondylodiscitis and infection with less virulent organisms, the clinical picture often is confusing and the initial radiologic and hematologic studies do not contribute much toward establishing the diagnosis. Methods Demographic pattern, predisposing factors, clinical presentation, comorbidities, microbiology, treatment, neurologic recovery, and complications of 11 patients were prospectively reviewed regarding their contribution toward the conformation of diagnosis of subacute pyogenic discitis. Results Mean age at presentation was 46.0 years with average preoperative Oswestry Disability Index and Visual Analog Scale scores of 83.4 and 7.18, respectively. Mean follow-up duration was 12.0 months. The most common site of infection was the lumbar spine, followed by the thoracic spine (n=1). Infective organisms were isolated in only 45% of cases. Staphylococcus aureus was the most common causative organism isolated. Conclusions Diagnosing subacute spondylodiscitis in a patient presenting with subacute low backache poses a diagnostic challenge. Clinical and radiologic picture are deceiving, and bacteriologic results often are negative, further complicating the picture. A detailed medical history along with clinical, radiologic, and biochemical parameters prevents missing the diagnosis. Serial serum Creactive protein and alkaline phosphatases were more reliable blood parameters in cases of subacute presentation.

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“…Relatively few spinal infection studies specifically deal with older populations, and data on spinal infections in adults is similarly sparse. 60 …”

Section: Clinical Manifestationsmentioning

confidence: 99%

Spondylodiscitis revisited

et al. 2017

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Spondylodiscitis may involve the vertebral bodies, intervertebral discs, paravertebral structures and spinal canal, with potentially high morbidity and mortality rates.A rise in the susceptible population and improved diagnosis have increased the reported incidence of the disease in recent years.Blood cultures, appropriate imaging and biopsy are essential for diagnosis and treatment.Most patients are successfully treated by conservative means; however, some patients may require surgical treatment.Surgical indications include doubtful diagnosis, progressive neurological deficits, progressive spinal deformity, failure to respond to treatment, and unresolved pain.Cite this article: EFORT Open Rev 2017;2:447–461. DOI: 10.1302/2058-5241.2.160062

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Spinal infections in older people: an analysis of demographics, presenting features, microbiology and outcomes

Abstract: Older patients with spinal infections present later, with higher inflammatory markers and fewer typical infective symptoms and signs; these may contribute to poorer outcomes. A low threshold for promptly investigating older patients with new or worsening back pain should be set.

Cited by 20 publications

References 27 publications

Red flags for the early detection of spinal infection in back pain patients

Red flags for the early detection of spinal infection in back pain patients

Evaluation of Challenges in Diagnosis of Spontaneous Subacute Pyogenic Spondylodiscitis in Immunocompetent Patients: Experiences from a Tertiary Care Center

Spondylodiscitis revisited

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