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Objectives and questions: Surgery can be beneficial for younger spondylodiscitis patients, especially with instability or neurological deficits. However, data on outcomes in an elderly population are limited. This study analyzes surgical outcomes in octogenarians with spondylodiscitis.

Material and methods: Patients who underwent surgical treatment for spondylodiscitis from June 2011 through December 2023 were included. Indication for surgery were severe infection with a failed conservative treatment, instability or neurological deficit. Patients with a minimum follow-up of one year were included in the study. They were divided into an octogenarian cohort (OG, age 80–89) and comparison cohort (CC) aged 60–69 years. The analysis covered demographics, comorbidities (e.g., diabetes, cardiovascular disease), Spondylodiscitis Infection Treatment Evaluation Score (SITE), surgical details, complications and the one-year mortality.

Results: A total of 37 Patient met the inclusion criteria (OG n=20, CC n=17). The mean follow-up was 3.5 years (SD ± 2.0 years) with a male-to-female ratio of 45.0% to 55.0% in the OG group and 58.8% to 41.2% in the CC group. Preoperatively, 10.0 % of the OG and 23.5% of the CC were septic. 40% of the OG and 47.1% of the CC had preoperative lumbal epidural or paravertebral abscesses. 5% of the OG and 5.9% of the CC cohort had preoperative thoracal epidural or paravertebral abscesses. The preoperative SITE score averaged 7.8 (SD ±1.9) in the OG and 8.2 (SD ±1.1) in the CC cohort. Patients in the OG cohort underwent more frequently postoperative monitoring in the intensive care unit (OG 85.0% vs CC 64.7%, p=0.152). Additionally, they exhibited a higher incidence of postoperative acute renal failure (OG 40.0% vs CC 35.3%, p=0.769). Within the follow-up they required surgical revision more frequently (OG 40.0% vs. CC 11.8%, p=0.054) and the one-year mortality was higher in the OG cohort (OG 45.0% vs CC 23.5%, p=0.173).

Discussion and conclusions: If surgery is indicated in octogenarians, patients exhibit poorer outcomes within the first year following treated spondylodiscitis. Treatment necessitates a comprehensive and individualized approach that takes into account the complexities of aging and the potential for multiple comorbidities. The involvement of a multidisciplinary team is crucial in providing holistic care and addressing the diverse needs of elderly patients suffering from spondylodiscitis.