Pyogenic Spondylitis in Elderly Patients

Pyogenic spondylitis is a rare and probably under- diagnosed condition (incidence: 2 to 3 out of every 100,000 people in Europe). It is more common among elderly patients over the age of 60, and its prevalence increases with age. It represents 2 to 4% of osteoarticular infections. Phy- siopathologically, we should differentiate between haemato- genous spondylitis, which occurs with septicaemia with secondary grafting on the spine and which is the most common, and secondary or contiguous spondylitis, which arises in a postoperative context or after a procedure on the spine such as infiltration, and affects younger patients. The clinical presentation is aspecific and often torpid, with an absence of fever in half of all cases. The most frequent symp- tom is spinal pain. CRP is generally heightened, averaging at around 120 mg/l. The bacteria most frequently responsible for spondylitis are staphylococcus and streptococcus. The microbiological documentation on spondylitis is a signifi- cant way of being able to conduct treatment and adapt it in the event of intolerance. There are three vectors for the treatment of this condition: antibiotic therapy, surgery and immobilisation. The prognosis for this condition is good, including in elderly patients, and neurological complications are rare. These appear to be characteristic of Mycobacte- rium tuberculosis (not dealt with here) and Staphylococ- cus aureus infections.