When was the last time you diagnosed a spinal abscess? I’ve seen 4 in 6 months (before that, one in 6.5 years), and when I tweeted out today’s article, colleagues echoed similar experiences. This retrospective case series study reviewed the incidence of spinal abscesses in Kentucky at the University of Kentucky, as well as the association of spinal abscesses with IV drug abuse.
Kentucky ranks 26th in population in the US and also has the 4th highest number of prescribed scheduled medications. The authors report that legislation was passed in July of 2012 which focused on stricter monitoring and regulation of pain clinics and prescription drug abuse, partially through the use of an electronic prescription monitoring system. They go on to state that while prescription abuse decreased, there was a surge in IV heroin use (whether it was moving up the opiate abuse ladder, or because that was the only opiate they could find remain to be seen).
The number of spinal abscesses from 2010-2014 were as follows: 16, 26, 25, 38, 67.
The number of abscess with associated IVDA were as follows: 3, 5, 3, 7, 27.
Percentage of spinal abscesses with IVDA (2010-14): 19%, 19%, 12%, 18%, 40%
While the authors touted a 9 fold increased in the incidence of diagnosed spinal abscesses with a history of IVDA from 2010 to 2014, the number of times spinal abscess was diagnosed had increased over 4 fold (perhaps due to looking more, or from increased availability of MRI, or both). There was a big jump in 2014, as the percentage of patients with a spinal abscess has gone up to 40%; whether this high a percentage of spinal abscess patients are IVDA’ers or not remains to be seen. I reached out to a colleague who works in spinal surgery to pick his brain on this to see if his practice has seen similar change:
“I would say the vast majority of epidural abscesses we see tend to be older patients with diabetes and remote h/o bacteremia or previous surgery. I would say we see a young- ish IVDA associated abscess every, 2 or 3 months”
Take home points? Spinal abscesses may be on the rise – but keep in mind that over 50% do NOT have a history of IVDA.