1. Spinal Infections in the Elderly Manoj Krishna Spine Surgeon www.spinalsurgeon.com

2. Case 1 94 year old Increasing back pain for 6 weeks Dental filling 6 weeks ago No fever/Night Sweats/Loss of weight Some loss of appetite but feels well Pain is severe- unable to walk – in a wheelchair No local tenderness- but points to lumbo-sacral spine No neuro-deficit Unsteady gait with poor balance

3. Case 1 Has a high signal in L34 on the T2 MRI scan, and low signal on T1. Indicates fluid in the disc- most likely an infection In addition has severe spinal stenosis at L34 and L45 – as seen on the cross section. Fluid in Disc Severe Stenosis

4. Case ESR=34, CRP= 30. Not Diabetic Lives alone Treated with disc biopsy and antibiotics for 3 months Moved to care home after discharge

5. Learning points The only clue this was an infection was the loss of appetite- otherwise presented like a degenerative problem Raised ESR and CRP are a strong indicator of an infection- do the tests early on MRI is essential to an early diagnosis- otherwise could have been fatal Most spinal infections now present without a fever Loss of appetite or feeling unwell are early clues

6. Learning points Suspect infection when severe back pain present in the following: The Elderly Diabetics Rheumatoid arthritis On steroids While recovering from a urinary or chest infection