Story by: Erica Coghill on November 8, 2018
Physicians are seeing more cases of an otherwise rare spine infection — osteomyelitis — that can be caused by injecting bacteria along with heroin.
Heroin users risk showering their bloodstream with bacteria that live on their skin and needles. The bacteria can travel to the spine, plant there and fester into a painful infection.
A recent Norton Leatherman Spine study took a closer look at osteomyelitis patients. The study revealed the number of Norton Leatherman Spine patients with spine infections that required surgery increased twelvefold from 2012 to 2016.
“It used to be that the majority of our osteomyelitis patients were elderly, sick diabetics, but the heroin epidemic has really changed that patient demographic,” said Jeffrey L. Gum, M.D., a Norton Leatherman Spine surgeon.
In 2012, Norton Leatherman Spine saw only five patients with these serious spine infections. and intravenous drug use wasn’t a cause in any of them. By 2016 that number had grown to more than 100, with the majority of them coming from patients using intravenous drugs. Doctors also found that most patients were too far along to avoid surgery.
While antibiotics will take care of most spine infections early on, Dr. Gum said intravenous drug users tend to ignore the symptoms of osteomyelitis.
“It is normally more advanced when we see them,” Dr. Gum said.
Some patients are paralyzed by the time they come in. If caught soon enough, surgery can improve the paralysis. Most patients experience back pain. They can experience leg pain if the infection is pressing on a nerve root or if the spinal cord is feeling the pressure, arms or legs become weak.
Osteomyelitis surgery typically consists of two procedures. “In the first surgery, we remove the infection in the disc and bone in the front of the spine,” Dr. Gum said. “Then, in the second procedure we go in the back of the spine and stabilize it with screws and rods.”
It takes months — including a couple of weeks in the hospital — for patients with intravenous drug-induced osteomyelitis to recover from surgery.
The patients’ drug use complicates their recovery time. After surgery, patients still need to be on antibiotics, which normally are delivered through a catheter in a vein — a peripherally inserted central catheter (PICC) line.
“If there is a history of drug use, we cannot use a PICC line on those patients, due to concern that when they leave, they might shoot up through the PICC line,” Dr. Gum said.
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The influx of heroin-addicted patients seeking help at Norton Leatherman Spine led its physicians to explore ways to help fix the opioid epidemic. According to the National Institute on Drug Abuse, about 80 percent of people who use heroin first misused prescription opioids.
Norton Leatherman Spine physicians are taking additional steps to protect its patients from the risk of addiction after surgery. “We realize that the opioid issue in this area is a serious problem, and we are doing everything we can to develop techniques and strategies to help reduce it within spine care,” Dr. Gum said.
Those techniques and strategies span from research to innovative robotic technology that assists in spinal surgeries. Robotic technology increases precision, reduces pain and allows patients to take fewer medications.
Norton Leatherman Spine researchers recently studied spine patients given opioid pain relievers in the hospital after surgery. “This study was meant to bring us steps closer to reducing opioid use,” Dr. Gum said.
Researchers discovered that several factors play a role in the amount of opioids used after a spine surgery. The invasiveness of the surgery, the amount of opioids patients take before surgery, and how opioids are prescribed after surgery — paired with over-the-counter pain relievers — all played a role.
“If we can do less invasive surgeries through smaller incisions, that brings us steps closer to reducing opioids needed,” Dr. Gum said. “We are very close to performing opioid-less surgeries at Norton Leatherman Spine.”
In addition to smaller incisions, Dr. Gum said efforts by the anesthesia team to develop creative ways to control pain without opioids are producing amazing results that soon will be presented nationally and published in spine literature.
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