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Spinal Infections

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Brain and Spine Surgery in the Elderly

Abstract

The number of spinal infections seems to have increased as a result of increasing aging population, immunocompromised hosts, or intravenous drug users. For early diagnosis of spinal infection, magnetic resonance imaging is a useful tool that can yield positive results just 3 to 5 days after onset. Organism identification is very important for selecting appropriate antibiotics. Therefore, specimens must be collected from the locus of infection for culture in addition to blood cultures before the administration of antibiotics, even in the elderly. Staphylococcus aureus is the most commonly isolated pathogen. In elderly patients with implants such as pacemakers, prosthetic joints, and other prosthetic materials, Staphylococcus epidermidis is a possible pathogen. Escherichia coli and Proteus species from genitourinary tract infections are more likely in the elderly. The elderly are more frequently infected with drug-resistant pathogens. Based on pathogens identified from culture material, appropriate antibiotic selection should involve consideration of antimicrobial susceptibility and spinal tissue penetration. Although the optimal duration remains unknown, antimicrobial therapy for spinal infections should be longer than for most other types of infections. The gold standard surgical treatment for spinal infection is radical debridement followed by autologous strut bone grafting. Recently, the addition of posterior instrumentation has become popular. In the elderly, posterior instrumentation without anterior manipulation is an alternative surgical option. If there is dramatic pain relief, observation can be reasonable. If pain relief is inadequate or there is a possibility of progressive deformity, additional anterior debridement and bone grafting could be scheduled.

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  1. Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan

    Hideki Nagashima MD, DMSc

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    Moncef Berhouma

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    Pierre Krolak-Salmon

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Nagashima, H. (2017). Spinal Infections. In: Berhouma, M., Krolak-Salmon, P. (eds) Brain and Spine Surgery in the Elderly. Springer, Cham. https://doi.org/10.1007/978-3-319-40232-1_18

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