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Chronic liver failure and concomitant distant infections are associated with high rates of neurological involvement in pyogenic spinal infections.

Spine 2009 April 2
STUDY DESIGN: A retrospective study of a consecutive series of all patients with pyogenic spinal infections treated at a single institution over a 10-year period.

OBJECTIVE: To investigate risk factors for neurologic impairment with pyogenic spinal infections.

SUMMARY OF BACKGROUND DATA: Pyogenic spinal infections are frequently associated with neurologic deficit at the time of initial diagnosis. Current evidence suggests that advanced age, diabetes mellitus, rheumatoid arthritis, systemic corticosteroid therapy, impaired immune status, infection with Staphylococcus aureus, and more proximal infections are risk factors for neurologic involvement. To the authors' knowledge, however, the influence of chronic liver failure or concomitant nonspinal infection has not been previously investigated.

METHODS: A review of all patients discharged with a diagnosis of pyogenic spinal infection was performed. Data were collected, including age, sex, site of infection, degree of neurologic impairment, bacterial organism isolated, and various medical comorbidities such as diabetes mellitus, rheumatoid arthritis, chronic corticosteroid therapy, chronic liver failure, chronic renal failure, smoking, human immunodeficiency virus infection, intravenous drug abuse, cancer, cardiac disease, and the presence of a distant, nonspinal site of infection.

RESULTS: Fifty-five consecutive patients with pyogenic spinal infections were identified. Statistical analysis demonstrated that the presence of an epidural abscess, chronic liver failure, or a distant nonspinal infection were the only significant risk factors for neurologic involvement.

CONCLUSION: The current data suggest that chronic liver failure and the presence of a distant nonspinal infection are possible risk factors for neurologic involvement in patients with pyogenic spinal infections. These risk factors have not been previously described. This knowledge warrants closer surveillance for neurologic deficit in patients with these conditions.

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