Infectious Spondylodiscitis in the Elderly in a Rheumatological Setting in Togo

Abstract

Infectious spondylodiscitis in the elderly is a diagnostic and therapeutic emergency. They are mainly a functional and sometimes vital prognosis issue, with long-term chronic disabling sequelae and significant social costs. Study aim: To describe the epidemiological, clinical, paraclinical, therapeutic and evolutionary aspects of infectious spondylodiscitis in the elderly in a rheumatological setting in Togo. Patients and methods: This was a multicenter, cross-sectional study conducted on the records of patients aged at least 65 years, suffering from infectious spondylodiscitis and hospitalized in four rheumatology units from their respective opening dates till December 31, 2020. Data collection lasted three months (December 1, 2020 to February 29, 2021). The diagnosis of infectious spondylodiscitis was radioclinical and laboratory-based. Results: 83 (49 women, 34 men) of the 1281 patients (6.48%) examined had infectious spondylodiscitis. The mean age at consultation was 70.59 ± 5.09 years, and the mean duration of the clinical course was 12 months. Spondylodiscitis was of tuberculous etiology (89.20%). It was most often found in the lumbar (56.62%) and dorsal (21.69%) segments. The location was multifocal in 12.05% of cases. It was associated with pulmonary involvement in 22.64% of cases. A neurological complication was identified in 48.19%. The main risk factors identified were promiscuity (48.82%), chronic alcoholism (18.07%), HIV infection (8.43%), diabetes (6.03%) and sickle cell disease (6.03%). The clinical course under medical treatment was favorable in 57 patients (68.68%). Conclusion: Infectious spondylodiscitis remains a frequent reason for hospitalization, tuberculosis being the most frequent etiology. Multifocal location, deterioration of general condition, gibbosity and neurological complications are exclusive to the elderly subject.