title: Spinal infection in intravenous drug abusers.
abstract: The number of intravenous (IV) drug abusers has been increasing in recent years. They are generally younger and healthier than the typical patient with a spinal infection. Reviewing the English language literature, there are only a few articles discussing the relationship between IV drug abuse and spinal infection. We studied 21 IV drug abusers with spinal infection. All were male, 19 were in their 30s and 40s with a mean age of 44 years. The mean follow-up period was 41 months after surgical intervention. Mild and severe neurologic deficit were seen in 5 and 13 patients (Frankel Grade C in 5, Grade D in 8), respectively. The overall positive culture rate was 17 out of 21 (81%). Twelve patients were infected with Staphylococcus aureus and 3 with Pseudomonas aeruginosa. Two had Mycobacterium tuberculosis. All were treated with anterior debridement and strut bone grafting with or without posterior instrumentation, laminectomy and abscess excision, or with additional discectomy. All patients with neurologic deficit recovered to a normal status. At the most recent follow-up, all the spine segments had fused and no one complained of any recurrent back pain. There were no postoperative complications. Physicians need to be more alert to the possibility of spinal infection in IV drug abusers with back pain. In addition to Staphylococcus aureus, Pseudomonas aeruginosa and Mycobacterium tuberculosis may be seen among IV drug abusers.
authors.affiliation: Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. chuo1111@yahoo.com.tw
authors.forename: Chin-Yi
authors.initials: CY
authors.lastname: Chuo
authors.forename: Yin-Chih
authors.initials: YC
authors.lastname: Fu
authors.forename: Yen-Mou
authors.initials: YM
authors.lastname: Lu
authors.forename: Jian-Chih
authors.initials: JC
authors.lastname: Chen
authors.forename: Wun-Jer
authors.initials: WJ
authors.lastname: Shen
authors.forename: Chung-Hsien
authors.initials: CH
authors.lastname: Yang
authors.forename: Cheng-Yen
authors.initials: CY
authors.lastname: Chen
mesh_terms: D000328:Adult; D017677:Age Distribution; D015299:Discitis / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D020802:Epidural Abscess / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D006801:Humans; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D015819:Substance Abuse, Intravenous / Q000150:complications*; D013904:Thoracic Vertebrae; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000209:etiology* / Q000473:pathology / Q000628:therapy