Introduction: Intravenous drug abuse (IVDA) associated spinal epidural abscesses (SEA) are an unfortunate sequela of the opioid crises in the United States.
Methods: This study is a retrospective chart review of patients presenting with IVDA associated SEA at our institution from 2013 – 2018, spanning the state-wide implementation of opioid prescribing restrictions.
Results: 45 patients presented with IVDA associated SEA. 46.5% presented with a neurologic deficit. 31 patients underwent surgery, either for neurologic deficit, failure of medical therapy or both. 19 surgical patients underwent a fusion procedure along with decompression. The complication rate was 41.9% and the mortality rate was 6.7%. The average length of stay was 27.6 days. Patients operated on within 24 hours of onset of neurologic symptoms trended toward more improvement in AIS grade compared to those who did not (0.5 vs. -0.2, p = 0.068). 57.8% of patients had MRSA isolated as the causative pathogen. 23 patients (51.5%) kept their scheduled clinic follow up appointments. Of the fusion patients with adequate follow up, 5 showed bony arthrodesis and 3 had pseudoarthroses. The rate of IVDA associate SEA increased after opioid prescribing restrictions were put in place, from 0.54 cases per month to 1.15 cases per month (p = .017).
Conclusions: Patients with IVDA associated SEA are challenging to treat, with high complication rates and poor follow-up. This disease is increasing in frequency and opioid prescribing restrictions did not slow that rise. Community outreach to promote prevention, early medical attention and medication compliance would benefit this largely publicly funded patient population.
Patient Care: We hope our case series will help guide physicians' decisions in treating patients presenting with IV drug associated spinal epidural abscesses.
Learning Objectives: By the conclusion of this session, we hope that participants will identify issues that make patients presenting with IV drug associated spinal epidural abscesses especially challenging to treat. They will also consider policy initiatives to help slow the increasing rate of this devastating disease.