Pyogenic osteomyelitis of the spine in the elderly: three cases of a synchronous non-axial infection by a different pathogen

Study design: A retrospective chart review of patients over 65 years of age treated at the Spine Care Unit for pyogenic vertebral osteomyelitis. Objectives: To assess the reliability of peripheral blood, urine and sputum cultures in the treatment of pyogenic vertebral osteomyelitis in the elderly. Setting: Study performed at the Spine Care Unit, Meir Hospital, Kfar-Saba, Israel. Methods: The Meir Hospital records were searched for patients over 65 years of age, treated at the Spine Care Unit for pyogenic vertebral osteomyelitis. Charts, culture results and imaging studies were reviewed. A medline literature search was performed to survey the literature regarding pyogenic vertebral osteomyelitis in the elderly with emphasis on diagnostic imaging modalities and surgical treatment. Results: Three patients were identified with concurrent peripheral infection by a different organism than the organism causing the vertebral osteomyelitis. Delay in correct diagnosis led to neurologic impairment in all patients and surgical treatment was performed in all three to drain the epidural abscess, decompress the spinal cord and obtain direct tissue culture. Following decompression and epidural abscess evacuation, one patient has functionally recovered and was ambulating with a cane, two patients did not recover and remained paraparetic and ambulate in a wheelchair. Conclusions: Pyogenic vertebral osteomyelitis in the elderly can be caused by a different pathogen than that isolated from blood, sputum or urine cultures. In the elderly, a biopsy of the vertebral lesion should be obtained for susceptibility studies prior to conservative treatment with bracing and intravenous antibiotics.