Wang Z et al. – There are significant differences in demographics, presentation, treatment and outcomes of primary spinal pyogenic infection between a population of IVDU and a comparable cohort of non–IVDU. The intravenous drug users (IVDU) group presents with cervical quadriplegia while it is the thoracolumbar spine that is almost exclusively involved in the non–IVDU group. Among the IVDUs, surgical management is complex with a high incidence of early hardware failure. SSI is significantly more common among non–IVDU. Significant neurological improvement can be expected in the majority of IVDU patients with a high mortality rate among the non–IVDU.