AB0938 PARTICULARITIES OF INFECTIOUS SPONDYLODISCITIS IN THE ELDERLY: COMPARATIVE STUDY WITH THE YOUNG SUBJECT
Authors: L. Ben Ammar, A. Ben Tekaya, M. Ben Hammamia, O. Saidane, S. Bouden, R. Tekaya, I. Mahmoud, L. Abdelmoula
Journal: Annals of the Rheumatic Diseases (2020)

Background: The incidence of infectious spondylodiscitis is steadily increasing. The prognosis depends on various parameters, including age. Objectives: To explore the differences in presentation and the results of further investigations and the prognosis of spondylodiscitis between young and elderly subjects. Methods: This is a retrospective study of 113 patients admitted to our department over a period of 20 years [1998-2018]. The epidemiological, clinical, biological, radiological and progressive aspects of spondylodiscitis in subjects over the age of 65 were compared to cases of spondylodiscitis in young subjects whose age is less than 65 years. Results: Of the 113 identified patients, 33 (29.2%) were classified as older, with male predominance in both groups (56.2 and 51.5% respectively; p=0.6). The presence of risk factors, particularly diabetes, was more frequent in the older subjects but without a statistically significant difference (p=0.2). Hepathopathies were also more frequent in the elderly but without statistically significant difference (p=0.3). The mean duration of progression was 3 months with no statistically significant difference between the two groups (4 and 5 months respectively, p=0.1). The presence of neurological symptoms, especially radiculalgia, was more frequently reported in younger subjects (p=0.01). Also, young subjects were more likely to have a fever (p=0.005). On the other hand, a biological inflammatory syndrome was more frequently encountered in older subjects (p=0.03). We found no statistically significant difference in the location of spondylodiscitis (p=0.4). Also, multifocal involvement was more frequent in older subjects but without a statistically significant difference. Radiologically, para-vertebral abscesses, epiduritis and spinal cord compression were more common in the elderly group (p=0.03; p=0.01 and p=0.01, respectively). While the frequency of intervertebral pinching and erosions was similar in both groups (p=0.1; p=0.8, respectively). Tuberculosis was the most involved germ in more than 50% of cases with no statistically significant difference between the two groups (57.5 and 51.5% respectively; p=0.5). All patients received targeted antibiotic therapy. The occurrence of immediate complications was more frequent in the elderly but without a statistically significant difference (p=0.1). They included neurological complications (spinal cord compression and Cauda equina s yndrome ) that occurred in 6.3% of cases in younger subjects versus 36.4% of cases in the elderly (p=0.07). Followed by treatment side effects dominated by disturbance of liver function due mainly to antituberculosis drugs occurring in 16.3% of cases in the younger group and 15.2% of cases in older subjects (p=0.8). Finally, there were 2 deaths in each group (p=0.5). Conclusion: Our series has shown that the picture of spondylodiscitis in the elderly is less noisy. However, the neurological damage is more pronounced on imaging. The misleading symptomatology in the elderly explains the delay in diagnosis and treatment, which leads to more frequent complications and excess mortality. Disclosure of Interests: None declared