I once saw a patient come in with lower back pain without a history of recent traumas or injuries. The patient’s background history showed a continuing history of IV drug use. More recently, the patient had started injecting in his legs.
As would later be explained to me by the doctor, this clinical picture raises some red flags. The Batson venous plexus is a network of valveless veins connecting the deep pelvic veins and the thoracic veins to the internal vertebral venous plexus. Because of its valveless quality, the flow of blood through the plexus is slow and predisposes to cancer metastasis and bacterial seeding.
With IV drug use, the main worry is an epidural abscess related to a dirty needle. The patient presents with progressive back pain or radicular pain, fever and eventual neurological deficits in the affected spinal levels. The eventual complication that we are worried about is osteomyelitis or the erosion of the vertebrae themselves.