{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T09:47:02Z","timestamp":1792057622459,"version":"4.4.0"},"reference-count":38,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2014,8]]},"abstract":"<jats:sec>\n                    <jats:title>Object<\/jats:title>\n                    <jats:p>Primary spine infection secondary to intravenous drug abuse (IVDA) is a difficult clinical entity encountered by spine surgeons and infectious disease specialists. Patients tend to be noncompliant with the treatment and follow-up, and some continue to use IV recreational drugs even after the diagnosis of spine infection. The authors undertook this study to analyze the presentation, etiology, demographic characteristics, treatment, and outcome of primary pyogenic spinal infection in patients with IVDA as the major risk factor.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The medical records, radiology imaging, and laboratory results (white blood cell count, inflammatory markers, bacteriology cultures) of all patients with pyogenic spine infection and history of IVDA presenting to a tertiary care center from August 2005 through December 2013 were retrospectively reviewed. The department of neurosurgery database and the hospital electronic medical records of University Hospital in San Antonio were used to identify the cohort for our study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 164 patients with spinal infection were evaluated during the study period; 102 of these patients had a history of IVDA. Their average age was 45.4 years, and only 14 (13.7%) were women. The mean laboratory values at presentation included a white blood cell count of 11.1 \u00d7 10\n                      <jats:sup>3<\/jats:sup>\n                      cells\/\u03bcl (range 0.5\u201332 \u00d7 10\n                      <jats:sup>3<\/jats:sup>\n                      cells\/\u03bcl), erythrocyte sedimentation rate (ESR) of 74 mm\/hr (range 9.9\u2013140 mm\/hr), and C-reactive protein (CRP) level of 67 mg\/L (range 0.1\u2013327 mg\/L). Twenty-six patients (25.4%) had an associated epidural abscess. The most common organism isolated from cultures of the bone and\/or blood was methicillin-sensitive\n                      <jats:italic>Staphylococcus aureus<\/jats:italic>\n                      (MSSA), which was found in 37 cases. A close second was methicillin-resistant\n                      <jats:italic>S. aureus<\/jats:italic>\n                      (MRSA), found in 23 cases. The most commonly involved region was the lumbar spine (24 cases [57.8%]), and most patients (69.6%) had involvement of only a single level. Eighty patients were initially treated with long-term IV antibiotic therapy, and only 22 underwent surgical intervention (24 procedures). Of the latter group, 8 patients underwent laminectomy alone while 16 required some type of instrumented stabilization. Of the patients requiring stabilization procedures, 2 (12.5%) required reoperation with extension of their surgical constructs to other levels. The average follow-up was 29.7 weeks (range 6 weeks to 3 years).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Diagnosis and management of spinal infection in patients with a history of IVDA is challenging. The data from this study show that initial laboratory values are difficult to interpret given that only a minority of these patients present with leukocytosis. Back pain was the only reliable predictor of spine infection. The authors' experience indicates that the majority of patients with spine infection and a history of IVDA can be successfully treated with IV antibiotic therapy alone.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2014.6.focus14148","type":"journal-article","created":{"date-parts":[[2014,8,1]],"date-time":"2014-08-01T03:47:18Z","timestamp":1406864838000},"page":"E3","source":"Crossref","is-referenced-by-count":56,"title":["Diagnosis and management of primary pyogenic spinal infections in intravenous recreational drug users"],"prefix":"10.3171","volume":"37","author":[{"given":"Mateo","family":"Ziu","sequence":"first","affiliation":[{"name":"Seton Brain and Spine Institute, Austin; and"},{"name":"Department of Neurosurgery, University of Texas Health Science Center in San Antonio, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley","family":"Dengler","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Texas Health Science Center in San Antonio, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davin","family":"Cordell","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Texas Health Science Center in San Antonio, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viktor","family":"Bartanusz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Texas Health Science Center in San Antonio, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus14148","series-title":"Scand J Infect Dis","first-page":"527","article-title":"Vertebral osteomyelitis in G\u00f6teborg, Sweden: a retrospective study of patients during 1990-95","volume":"33","author":"Beronius","year":"2001"},{"key":"b2-focus14148","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2695","DOI":"10.1097\/01.brs.0000244662.78725.37","article-title":"Nontuberculous pyogenic spinal infection in adults: a 12-year experience from a tertiary referral center","volume":"31","author":"Butler","year":"2006"},{"key":"b3-focus14148","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"780","DOI":"10.1097\/00007632-199704010-00015","article-title":"The clinical use of magnetic resonance imaging in pyogenic vertebral osteomyelitis","volume":"22","author":"Carragee","year":"1997"},{"key":"b4-focus14148","series-title":"Scand J Infect Dis","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1080\/003655498750003537","article-title":"Vertebral osteomyelitis at a Norwegian university hospital 1987-97: clinical features, laboratory findings and outcome","volume":"30","author":"Chelsom","year":"1998"},{"key":"b5-focus14148","series-title":"J Spinal Disord Tech","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1097\/BSD.0b013e31802c144a","article-title":"Spinal infection in intravenous drug abusers","volume":"20","author":"Chuo","year":"2007"},{"key":"b6-focus14148","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"1945","DOI":"10.1056\/NEJMra042823","article-title":"Bacterial infections in drug users","volume":"353","author":"Gordon","year":"2005"},{"issue":"6","key":"b7-focus14148","series-title":"Neurosurg Focus","first-page":"E4","article-title":"Surgical strategies for vertebral osteomyelitis and epidural abscess","volume":"17","author":"Hsieh","year":"2004"},{"issue":"Suppl 3","key":"b8-focus14148","series-title":"Eur Radiol","first-page":"E43","article-title":"Vertebral infection","volume":"14","author":"Jevtic","year":"2004"},{"key":"b9-focus14148","series-title":"Clin Infect Dis","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1086\/505118","article-title":"Do follow-up imaging examinations provide useful prognostic information in patients with spine infection?","volume":"43","author":"Kowalski","year":"2006"},{"key":"b10-focus14148","series-title":"Acta Orthop Scand","doi-asserted-by":"publisher","first-page":"513","DOI":"10.3109\/17453679808997789","article-title":"Epidemiology of acute vertebral osteomyelitis in Denmark: 137 cases in Denmark 1978-1982, compared to cases reported to the National Patient Register 1991-1993","volume":"69","author":"Krogsgaard","year":"1998"},{"issue":"6","key":"b11-focus14148","series-title":"Neurosurg Focus","first-page":"E3","article-title":"Nonspecific pyogenic spondylodiscitis: clinical manifestations, surgical treatment, and outcome in 24 patients","volume":"17","author":"Mann","year":"2004"},{"key":"b12-focus14148","series-title":"Semin Arthritis Rheum","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1053\/sarh.2002.29492","article-title":"Spontaneous pyogenic vertebral osteomyelitis in nondrug users","volume":"31","author":"Nolla","year":"2002"},{"key":"b13-focus14148","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"E246","DOI":"10.1097\/BRS.0b013e31816b8872","article-title":"Long-term functional outcome in pyogenic spinal infection","volume":"33","author":"O'Daly","year":"2008"},{"key":"b14-focus14148","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1016\/0090-3019(90)90047-S","article-title":"Diagnosis and management of pyogenic vertebral osteomyelitis in adults","volume":"33","author":"Osenbach","year":"1990"},{"key":"b15-focus14148","series-title":"Clin Orthop Relat Res","first-page":"178","article-title":"Analysis of 61 cases of vertebral osteomyelitis","volume":"1991","author":"Patzakis","year":"1991"},{"issue":"6","key":"b16-focus14148","series-title":"Neurosurg Focus","first-page":"E1","article-title":"General principles in the medical and surgical management of spinal infections: a multidisciplinary approach","volume":"17","author":"Qui\u00f1ones-Hinojosa","year":"2004"},{"key":"b17-focus14148","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1018","DOI":"10.1097\/00006123-199905000-00047","article-title":"Contemporary management of spinal osteomyelitis","volume":"44","author":"Rezai","year":"1999"},{"key":"b18-focus14148","series-title":"Rev Infect Dis","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1093\/clinids\/2.2.196","article-title":"Vertebral osteomyelitis in intravenous drug abusers: report of three cases and review of the literature","volume":"2","author":"Sapico","year":"1980"},{"key":"b19-focus14148","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1097\/BRS.0b013e31823b01b8","article-title":"Primary pyogenic infection of the spine in intravenous drug users: a prospective observational study","volume":"37","author":"Wang","year":"2012"},{"key":"b1-focus14148","series-title":"Scand J Infect Dis","first-page":"527","article-title":"Vertebral osteomyelitis in G\u00f6teborg, Sweden: a retrospective study of patients during 1990-95","volume":"33","author":"Beronius","year":"2001"},{"key":"b2-focus14148","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2695","DOI":"10.1097\/01.brs.0000244662.78725.37","article-title":"Nontuberculous pyogenic spinal infection in adults: a 12-year experience from a tertiary referral center","volume":"31","author":"Butler","year":"2006"},{"key":"b3-focus14148","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"780","DOI":"10.1097\/00007632-199704010-00015","article-title":"The clinical use of magnetic resonance imaging in pyogenic vertebral osteomyelitis","volume":"22","author":"Carragee","year":"1997"},{"key":"b4-focus14148","series-title":"Scand J Infect Dis","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1080\/003655498750003537","article-title":"Vertebral osteomyelitis at a Norwegian university hospital 1987-97: clinical features, laboratory findings and outcome","volume":"30","author":"Chelsom","year":"1998"},{"key":"b5-focus14148","series-title":"J Spinal Disord Tech","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1097\/BSD.0b013e31802c144a","article-title":"Spinal infection in intravenous drug abusers","volume":"20","author":"Chuo","year":"2007"},{"key":"b6-focus14148","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"1945","DOI":"10.1056\/NEJMra042823","article-title":"Bacterial infections in drug users","volume":"353","author":"Gordon","year":"2005"},{"issue":"6","key":"b7-focus14148","series-title":"Neurosurg Focus","first-page":"E4","article-title":"Surgical strategies for vertebral osteomyelitis and epidural abscess","volume":"17","author":"Hsieh","year":"2004"},{"issue":"Suppl 3","key":"b8-focus14148","series-title":"Eur Radiol","first-page":"E43","article-title":"Vertebral infection","volume":"14","author":"Jevtic","year":"2004"},{"key":"b9-focus14148","series-title":"Clin Infect Dis","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1086\/505118","article-title":"Do follow-up imaging examinations provide useful prognostic information in patients with spine infection?","volume":"43","author":"Kowalski","year":"2006"},{"key":"b10-focus14148","series-title":"Acta Orthop Scand","doi-asserted-by":"publisher","first-page":"513","DOI":"10.3109\/17453679808997789","article-title":"Epidemiology of acute vertebral osteomyelitis in Denmark: 137 cases in Denmark 1978-1982, compared to cases reported to the National Patient Register 1991-1993","volume":"69","author":"Krogsgaard","year":"1998"},{"issue":"6","key":"b11-focus14148","series-title":"Neurosurg Focus","first-page":"E3","article-title":"Nonspecific pyogenic spondylodiscitis: clinical manifestations, surgical treatment, and outcome in 24 patients","volume":"17","author":"Mann","year":"2004"},{"key":"b12-focus14148","series-title":"Semin Arthritis Rheum","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1053\/sarh.2002.29492","article-title":"Spontaneous pyogenic vertebral osteomyelitis in nondrug users","volume":"31","author":"Nolla","year":"2002"},{"key":"b13-focus14148","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"E246","DOI":"10.1097\/BRS.0b013e31816b8872","article-title":"Long-term functional outcome in pyogenic spinal infection","volume":"33","author":"O'Daly","year":"2008"},{"key":"b14-focus14148","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1016\/0090-3019(90)90047-S","article-title":"Diagnosis and management of pyogenic vertebral osteomyelitis in adults","volume":"33","author":"Osenbach","year":"1990"},{"key":"b15-focus14148","series-title":"Clin Orthop Relat Res","first-page":"178","article-title":"Analysis of 61 cases of vertebral osteomyelitis","volume":"1991","author":"Patzakis","year":"1991"},{"issue":"6","key":"b16-focus14148","series-title":"Neurosurg Focus","first-page":"E1","article-title":"General principles in the medical and surgical management of spinal infections: a multidisciplinary approach","volume":"17","author":"Qui\u00f1ones-Hinojosa","year":"2004"},{"key":"b17-focus14148","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1018","DOI":"10.1097\/00006123-199905000-00047","article-title":"Contemporary management of spinal osteomyelitis","volume":"44","author":"Rezai","year":"1999"},{"key":"b18-focus14148","series-title":"Rev Infect Dis","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1093\/clinids\/2.2.196","article-title":"Vertebral osteomyelitis in intravenous drug abusers: report of three cases and review of the literature","volume":"2","author":"Sapico","year":"1980"},{"key":"b19-focus14148","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1097\/BRS.0b013e31823b01b8","article-title":"Primary pyogenic infection of the spine in intravenous drug users: a prospective observational study","volume":"37","author":"Wang","year":"2012"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/37\/2\/article-pE3.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/37\/2\/article-pE3.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/37\/2\/article-pE3.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T08:42:54Z","timestamp":1780130574000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/37\/2\/article-pE3.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,8]]},"references-count":38,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2014.6.focus14148","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,8]]}}}