• Julio Urrutia, Christopher M Bono, Pablo Mery, Claudio Rojas, Natalia Gana, and Mauricio Campos.
• Department of Orthopaedic Surgery, Pontificia Universidad Catolica de Chile, Marcoleta, Santiago, Chile. jurrutia@med.puc.cl
• Spine. 2009 Apr 1; 34 (7): E240-4.

Study DesignA retrospective study of a consecutive series of all patients with pyogenic spinal infections treated at a single institution over a 10-year period.ObjectiveTo investigate risk factors for neurologic impairment with pyogenic spinal infections.Summary Of Background DataPyogenic 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.MethodsA 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.ResultsFifty-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.ConclusionThe 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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