Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jun;51(3):599-607.
doi: 10.1007/s15010-023-02024-9. Epub 2023 Apr 18.

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

Ayla Yagdiran #  1 , Gregor Paul #  2   3 , Charlotte Meyer-Schwickerath  4 , Justus Scheder-Bieschin  5 , David Tobys  6 , Nikolaus Kernich  1 , Peer Eysel  1 , Norma Jung  4
Affiliations

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

Ayla Yagdiran et al. Infection. 2023 Jun.

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.

Keywords: Comorbidity; Psoas abscess; Spinal injection; Staphylococcus aureus; Survival; Vertebral osteomyelitis.

PubMed Disclaimer

Conflict of interest statement

Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members except for NJ. NJ has received lecture fees from Gilead, Infectopharm, MSD, Bayer; Medacta and Labor Stein and travel grants from Pfizer, Gilead, Basilea, Correvio, Pfizer and Novartis and grants from an observational study from Infectopharm.

Figures

Fig. 1
Fig. 1
Flow diagram showing study population selection
Fig. 2
Fig. 2
Kaplan–Meier survival curve of patients with vertebral osteomyelitis after spinal injection compared to native vertebral osteomyelitis. Kaplan–Meier analysis depicts a better 1-year survival rate of patients with vertebral osteomyelitis after spinal injection in comparison to vertebral osteomyelitis after spinal injection (log-rank P = 0.04). No survival data were available for one patient in the NVO group. In the NVO group 17 patients (7%) were lost to follow-up and 2 patients (4.5%) in the SIVO group
See this image and copyright information in PMC

References

    1. Friedly JL, Comstock BA, Turner JA, Heagerty PJ, Deyo RA, Sullivan SD, et al. A randomized trial of epidural glucocorticoid injections for spinal stenosis. N Engl J Med. 2014;371:11–21. doi: 10.1056/NEJMoa1313265. - DOI - PubMed
    1. Manchikanti L, Knezevic NN, Boswell MV, Kaye AD, Hirsch JA. Epidural injections for lumbar radiculopathy and spinal stenosis: a comparative systematic review and meta-analysis. Pain Physician. 2016;19:E365–410. doi: 10.36076/ppj/2016.19.E365. - DOI - PubMed
    1. Chou R, Hashimoto R, Friedly J, Fu R, Bougatsos C, Dana T, et al. Epidural corticosteroid injections for radiculopathy and spinal stenosis: a systematic review and meta-analysis. Ann Intern Med. 2015;163:373–381. doi: 10.7326/M15-0934. - DOI - PubMed
    1. Research C for DE and. FDA Drug Safety Communication: FDA requires label changes to warn of rare but serious neurologic problems after epidural corticosteroid injections for pain. FDA 2019.
    1. Goodman BS, Posecion LWF, Mallempati S, Bayazitoglu M. Complications and pitfalls of lumbar interlaminar and transforaminal epidural injections. Curr Rev Musculoskelet Med. 2008;1:212–222. doi: 10.1007/s12178-008-9035-2. - DOI - PMC - PubMed

LinkOut - more resources