Journal of Spine Practice

Published date: Nov 15 2025

Journal Title: Journal of Spine Practice

Issue title: Journal of Spine Practice (JSP): Volume 5, Issue 1

Pages: 11 - 19

DOI: 10.18502/jsp.v5i1.19011

Haruka Miyatahmiyata27@gmail.comDepartment of Neurosurgery, Kyoto Okamoto Memorial Hospital, Kyoto 613-0034

Masanori Gomimasanori_gomi@okamoto-hp.or.jpDepartment of Neurosurgery, Kyoto Okamoto Memorial Hospital, Kyoto 613-0034

Tomoaki Fujitafriendautumn2000@yahoo.co.jpDepartment of Neurosurgery, Kyoto Okamoto Memorial Hospital, Kyoto 613-0034

Ryo FujisawaDepartment of Neurosurgery, Kyoto Okamoto Memorial Hospital, Kyoto 613-0034

Yuki KitadaDepartment of Neurosurgery, Kyoto Okamoto Memorial Hospital, Kyoto 613-0034

Kimitoshi SatohDepartment of Neurosurgery, Kyoto Okamoto Memorial Hospital, Kyoto 613-0034

Shigeharu Fukaoshigefk@gmail.comDepartment of Neurosurgery, Kyoto Okamoto Memorial Hospital, Kyoto 613-0034

Objective
Pyogenic spondylitis is becoming more common due to population aging and increases in treatment-related bacterial infection. Additionally, improved access to magnetic resonance imaging has led to the identification of more cases of pyogenic spondylitis. However, pyogenic spondylitis can also occur in relatively young people. In this study, we compared background factors and the course of treatment between younger and older patients.

Methods
A retrospective review of our hospital database identified 35 consecutive cases of pyogenic spondylitis treated between 2019 and 2024. After eight exclusions, 27 patients were selected. Outcomes were compared between patients younger than 65 years (n=9) and those aged 65 years or older (n=18).

Results
There was no significant difference in sex, site of the lesion, or presence or absence of a causative bacterium according to age group. Atopic dermatitis was significantly more common in younger patients (n=5, 56% vs. n=0, 0%, p=0.007), while diabetes mellitus or prior bacterial infection was less common (n=3, 33% vs. n=16, 83%, p=0.003). Surgery was more common in younger patients (n=5, 56% vs n=6, 33%), as was discharge to home (n=8, 89% vs. n=6, 33%, p=0.01).

Conclusions
Diabetes mellitus and prior bacterial infection, which are known risk factors for pyogenic spondylitis, were less common in younger patients. Furthermore, atopic dermatitis was more common in younger patients. Owing to the breakdown of the skin barrier, atopic dermatitis is known to cause not only skin-limited infections but also bacteremia-associated conditions such as infective endocarditis and pyogenic arthritis. Our finding that younger patients are more likely to be discharged home highlights the importance of appropriate treatment.

Keywords: pyogenic spondylitis, vertebral osteomyelitis, epidural abscess, atopic dermatitis, spine, infection

[1] Sapico FL, Montgomerie JZ. Pyogenic vertebral osteomyelitis: report of nine cases and review of the literature. Rev Infect Dis. 1979;1(5):754-776.

[2] Hopkinson N, Stevenson J, Benjamin S. A case ascertainment study of septic discitis: clinical, microbiological and radiological features. Qjm. 2001;94(9):465-470.

[3] Lam KS, Webb JK. Discitis. Hosp Med. 2004;65(5):280-286.

[4] Yoshimoto M, Takebayashi T, Kawaguchi S, et al. Pyogenic spondylitis in the elderly: a report from Japan with the most aging society. Eur Spine J. 2011;20(4):649-654.

[5] Marchionni E, Marconi L, Ruinato D, Zamparini E, Gasbarrini A, Viale P. Spondylodiscitis: is really all well defined? Eur Rev Med Pharmacol Sci. 2019;23(2 Suppl):201-209.

[6] Cheung WY, Luk KD. Pyogenic spondylitis. Int Orthop. 2012;36(2):397-404.

[7] Dimar JR, Carreon LY, Glassman SD, Campbell MJ, Hartman MJ, Johnson JR. Treatment of pyogenic vertebral osteomyelitis with anterior debridement and fusion followed by delayed posterior spinal fusion. Spine (Phila Pa 1976). 2004;29(3):326-332; discussion 332.

[8] Ha KY, Shin JH, Kim KW, Na KH. The fate of anterior autogenous bone graft after anterior radical surgery with or without posterior instrumentation in the treatment of pyogenic lumbar spondylodiscitis. Spine (Phila Pa 1976). 2007;32(17):1856-1864.

[9] Pee YH, Park JD, Choi YG, Lee SH. Anterior debridement and fusion followed by posterior pedicle screw fixation in pyogenic spondylodiscitis: autologous iliac bone strut versus cage. J Neurosurg Spine. 2008;8(5):405-412.

[10] Darouiche RO. Spinal epidural abscess. N Engl J Med. 2006;355(19):2012-2020.

[11] Grammatico L, Baron S, Rusch E, et al. Epidemiology of vertebral osteomyelitis (VO) in France: analysis of hospital-discharge data 2002-2003. Epidemiol Infect. 2008;136(5):653-660.

[12] Zimmerli W. Clinical practice. Vertebral osteomyelitis. N Engl J Med. 2010;362(11):1022- 1029.

[13] Totté JE, van der Feltz WT, Hennekam M, van Belkum A, van Zuuren EJ, Pasmans SG. Prevalence and odds of Staphylococcus aureus carriage in atopic dermatitis: a systematic review and meta-analysis. Br J Dermatol. 2016;175(4):687- 695.

[14] Leung DY, Bieber T. Atopic dermatitis. Lancet. 2003;361(9352):151-160.

[15] Mohiyiddeen G, Brett I, Jude E. Infective endocarditis caused by Staphylococcus aureus in a patient with atopic dermatitis: a case report. J Med Case Rep. 2008;2:143.

[16] Yamamoto T, Yodogawa K, Wakita S, et al. Recurrent prosthetic valve endocarditis caused by Staphylococcus aureus colonizing skin lesions in severe atopic dermatitis. Intern Med. 2007;46(9):571-573.

[17] Berents TL, Carlsen KC, Mowinckel P, et al. Skin Barrier Function and Staphylococcus aureus Colonization in Vestibulum Nasi and Fauces in Healthy Infants and Infants with Eczema: A Population-Based Cohort Study. PLoS One. 2015;10(6):e0130145.

[18] Kitamura S, Nakayama Y, Shirai Y, Hashiguchi H, Kim R. Septic arthritis of the hip associated with atopic dermatitis. A case report. J Nippon Med Sch. 2000;67(6):464-467.

[19] Boiko S, Kaufman RA, Lucky AW. Osteomyelitis of the distal phalanges in three children with severe atopic dermatitis. Arch Dermatol. 1988;124(3):418-423.

[20] Mylona E, Samarkos M, Kakalou E, Fanourgiakis P, Skoutelis A. Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics. Semin Arthritis Rheum. 2009;39(1):10-17.

[21] Matsuo T, Hayashi K, Uehara Y, Mori N. The STAPH Score: A Predictor of Staphylococcus aureus as the Causative Microorganism of Native Vertebral Osteomyelitis. Open Forum Infect Dis. 2021;8(1):ofaa504.

[22] Cifu D, Seel, R., Kreutzer, J., Martwitz, J., McKinley, W., and Wisor, D. Age, outcome, and rehabilitation costs after tetraplegia spinal cord injury. NeuroRehabilitation. 1999;12:177-185.

[23] Kay ED, Deutsch A, Wuermser LA. Predicting walking at discharge from inpatient rehabilitation after a traumatic spinal cord injury. Arch Phys Med Rehabil. 2007;88(6):745-750.

[24] Newey ML, Sen PK, Fraser RD. The long-term outcome after central cord syndrome: a study of the natural history. J Bone Joint Surg Br. 2000;82(6):851-855.