Clinical features and outcome of vertebral osteomyelitis after spinal injection: is it worth the price?

Abstract

Purpose Spinal injections are increasingly used for back pain treatment. Vertebral osteomyelitis (VO) after spinal injection (SIVO) is rare, but patient characteristics and outcome have not been well characterized. The aim of this study was to assess patient characteristics of SIVO in comparison to patients with native vertebral osteomyelitis (NVO) and to determine predictors for 1-year survival. Methods This is a single-center cohort study from a tertiary referral hospital. This is a retrospective analysis of Patients with VO who were prospectively enrolled into a spine registry from 2008 to 2019. Student’s t-test, Kruskal–Wallis test or Chi-square test were applied for group comparisons. Survival analysis was performed using a log-rank test and a multivariable Cox regression model. Results 283 VO patients were enrolled in the study, of whom 44 (15.5%) had SIVO and 239 (84.5%) NVO. Patients with SIVO were significantly younger, had a lower Charlson comorbidity index and a shorter hospital stay compared to NVO. They also showed a higher rate of psoas abscesses and spinal empyema (38.6% [SIVO] vs. 20.9% [NVO]). Staphylococcus aureus (27%) and coagulase-negative staphylococci (CNS) (25%) were equally often detected in SIVO while S. aureus was more frequently than CNS in NVO (38.1% vs. 7.9%).Patients with SIVO (P = 0.04) had a higher 1-year survival rate (Fig. 1). After multivariate analysis, ASA score was associated with a lower 1-year survival in VO. Conclusion The results from this study emphasize unique clinical features of SIVO, which warrant that SIVO should be estimated as a separate entity of VO.

Identification of pathogen composition in a Chinese population with iatrogenic and native vertebral osteomyelitis by using mNGS

“…A total of 145 patients were included in this study, with 114 in the NVO group and 31 in the IVO group. The IVO group accounted for 21.3% of all included vertebral osteomyelitis cases, which is higher than the reported proportion of 10-15% in other studies [ 21 ]. However, the higher proportion of IVO in this study may be attributed to the fact that this study was conducted at the largest spinal surgery center in our province, and all IVO patients included in this study were referrals from lower-level hospitals, which may introduce certain selection bias.…”

Pyogenic Spondylodiscitis Following Nonspinal Cesarean Section

“…Less frequently, Pyogenic spondylodiscitis affects young patients without previous comorbidities, mainly after surgical procedures. Postoperative spondylodiscitis occurs mostly after spinal surgeries or interventions [ 4 ], with a lower incidence after non-spinal procedures [ 6 ].…”

“…Most commonly, the disease affects elderly immune-compromised patients. It was also reported in young healthy patients after surgical procedures, mainly interventions on the genitourinary system as well as those performed under spinal anesthesia [ 4 ].…”