Pyogenic Arthritis and Paraspinal Abscess Following Facet Joint Steroid Injection: A Case Report.
10.4184/jkss.2003.10.2.196
- Author:
Jae Chul LEE
1
;
Hyun Woo DOH
;
Young Il CHO
;
Kyung Je KIM
;
Yon Il KIM
;
Byung Joon SHIN
Author Information
1. Department of Orthopaedic Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea. schsbj@schbc.ac.kr
- Publication Type:Original Article
- Keywords:
Pyogenic facet joint infection;
Paraspinal intramuscular abscess;
Facet joint injection
- MeSH:
Abscess*;
Adult;
Anti-Bacterial Agents;
Arthritis*;
Debridement;
Drainage;
Fever;
Humans;
Low Back Pain;
Lumbar Vertebrae;
Spine;
Staphylococcus aureus;
Suppuration;
Tomography, X-Ray Computed;
Zygapophyseal Joint*
- From:Journal of Korean Society of Spine Surgery
2003;10(2):196-201
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
STUDY DESIGN: A case report and literature review. OBJECTIVES: To discuss pyogenic infections of the facet joints and paraspinal intramuscular abscess that developed after a steroid injection into the facet joint of the lower back. MATERIAL AND METHODS: A 39-year-old man who received a steroid injection to the facet joint, 3 weeks prior to admission, experienced increasing lower back pain and a high fever. RESULTS: Plain radiographs of the lumbar spine showed osteolytic erosion of the articular process at the L3-4 facet joint. On a CT scan, the destructed facet joint was connected to a paraspinal intramuscular abscess. MR images also showed a paraspinal intramuscular abscess on multiplane views. In the operative field, the paraspinal abscess, which extended from 2nd to 5th lumbar vertebrae, was found on the right side, with the L3-4 facet destructed and directly connected to the abscess. Some chalky material, considered to be steroid crystals, was found at the L3-4 facet joint. Drainage, debridement and irrigation were performed. Staphylococcus aureus was isolated from the culture. After surgery, intravenous antibiotics were administered, and the patients' symptoms quickly resolved. CONCLUSIONS: A posterior facet joint injection has its own risks of developing a pyogenic infection of the facet joint. Pyogenic facet joint infections may progress to a paraspinal intramuscular abscess. Surgical drainage is mandatory in cases resistant to antibiotic treatment, with evidence of pus formation on imaging studies.
