Herren Christian, von der Hoeh Nicolas Heinz, Zwingenberger Stefan, Sauer Daniel, Jung Norma, Pieroh Philipp, Drange Steffen, Pumberger Matthias, Scheyerer Max J
Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University, Germany.
Department of Orthopedic, Trauma and Plastic Surgery, University Hospital Leipzig, Germany.
Global Spine J. 2023 Apr;13(1_suppl):73S-84S. doi: 10.1177/21925682221121300.
Review article.
A review of literature on the treatment of pyogenic spondylodiscitis in geriatric patients was performed with the aim to give an overview about these special patients and a recommendation on necessary diagnostics as well as conservative and operative treatment options.
A systematic computerized literature search was done by the spondylodiscitis working group of the German Society for Orthopedics and Trauma Surgery.
Spondylodiscitis has an increasing incidence by age with a peak at 75 years or older. The 1-year mortality without an appropriate treatment is with 15 to 20% extremely high. Pathogen detection is the essential diagnostic step and the basis for a sufficient antibiotic treatment. Geriatric patients have initially less elevated inflammatory parameters. Compared to younger patients. They have a longer length of hospital stay and take longer for CRP normalization. Even the outcome between conservative and operative treatment is comparable after one year. Patients with spinal instability, immobilizing pain, epidural abscess, and newly emerged neurological deficits should be considered for operative treatment.
The treatment of geriatric patients with pyogenic spondylodiscitis must take into account that these patients usually have multiple comorbidities. The main goals are resistance-based antibiotics and the shortest possible time of immobilization of the patient.
综述文章。
对老年患者化脓性脊椎椎间盘炎的治疗文献进行综述，旨在概述这些特殊患者，并就必要的诊断以及保守和手术治疗方案提出建议。
德国骨科与创伤外科学会脊椎椎间盘炎工作组进行了系统的计算机文献检索。
脊椎椎间盘炎的发病率随年龄增长而增加，在75岁及以上达到峰值。未经适当治疗的1年死亡率高达15%至20%。病原体检测是关键的诊断步骤，也是充分抗生素治疗的基础。老年患者最初的炎症参数升高程度较低。与年轻患者相比，他们的住院时间更长，CRP恢复正常所需时间更长。即使保守治疗和手术治疗的结果在一年后相当。对于有脊柱不稳定、固定性疼痛、硬膜外脓肿和新出现神经功能缺损的患者，应考虑手术治疗。
老年化脓性脊椎椎间盘炎患者的治疗必须考虑到这些患者通常有多种合并症。主要目标是使用基于耐药性的抗生素，并使患者固定的时间尽可能短。
