Background: One of the major risk factors for spine infection is IV drug use and HIV infection. An increase in these risk factors has coincided with increased rates of spinal infection in Saskatchewan. However, the exact incidence and the clinical significance of spine infection associated with high-risk behavior is poorly understood. Methods: A retrospective review was completed for adult patients with discitis, osteomyelitis, or epidural abscess admitted to the Royal University Hospital, University of Saskatchewan over the last eight years. Results: This study included 176 patients consisting of 41% with discitis, 69% with osteomyelitis and 45% with epidural abscess. Overall mortality was 3% and 16% of patients developed severe disability.40% of patients were intravenous drug users, 45% were hepatitis C positive and 12% were HIV positive. For the initial four years of our study we experienced 72 patients. We experienced 91 cases over the past four years. Geographical analysis showed high incidence areas within the city of Saskatoon. Conclusions: High rates of IV drug use, Hepatitis C, and HIV have important implications in terms of what measures would assist in prevention of this condition. Secondary prevention or early identification of patients may reduce the number of patients who require lengthy admission, surgery and long term care for disablity.