High Risk Clinical Characteristics for Pyogenic Spinal Infection in Acute Neck or Back Pain: Prospective Cohort Study

Am J Emerg Med. 2020 Mar;38(3):491-496. doi: 10.1016/j.ajem.2019.05.025. Epub 2019 May 17.


Objective: To identify clinical characteristics associated with pyogenic spinal infection among adults presenting to a community emergency department (ED) with neck or back pain. A secondary objective was to describe the frequency of these characteristics among patients with spinal epidural abscess (SEA).

Methods: We conducted a prospective cohort study in a community ED enrolling adults with neck or back pain in whom the ED provider had clinical concern for pyogenic spinal infection. Study phase 1 (Jan 2004-Mar 2010) included patients with and without pyogenic spinal infection. Phase 2 (Apr 2010-Aug 2018) included only patients with pyogenic spinal infection. We performed univariate and multivariate analyses for association of clinical characteristics with pyogenic spinal infection.

Results: We enrolled 232 and analyzed 223 patients, 89 of whom had pyogenic spinal infection. The median age was 55 years and 102 patients (45.7%) were male. The clinical characteristics associated with pyogenic spinal infection on multivariate analysis of study phase 1 included recent soft tissue infection or bacteremia (OR 13.5, 95% CI 3.6 to 50.7), male sex (OR 5.0, 95% CI 2.5 to 10.0), and fever in the ED or prior to arrival (OR 2.8, 95% CI 1.3 to 6.0). Among patients with SEA (n = 61), 49 (80.3%) had at least one historical risk factor, 12 (19.7%) had fever in the ED, and 8 (13.1%) had a history of intravenous drug use.

Conclusion: Male sex, fever, and recent soft tissue infection or bacteremia were associated with pyogenic spinal infection in this prospective ED cohort.

Keywords: Back pain; Pyogenic spinal infection; Spinal epidural abscess; Spondylodiscitis; Vertebral osteomyelitis.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Back Pain / etiology*
  • Bacteremia / complications
  • Emergency Service, Hospital / statistics & numerical data
  • Epidural Abscess / epidemiology
  • Epidural Abscess / microbiology
  • Female
  • Fever / etiology
  • Humans
  • Male
  • Middle Aged
  • Neck Pain / etiology*
  • Prospective Studies
  • Risk Factors
  • Sex Factors
  • Soft Tissue Infections / complications
  • Spinal Cord Diseases / diagnosis*
  • Spinal Cord Diseases / epidemiology
  • Spinal Cord Diseases / etiology
  • Spinal Cord Diseases / microbiology