Abstract
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, expe-rienced 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 per-formed. Staphylococcus aureus was isolated from the culture. A fter 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.
REFERENCES
1). Baker A., Ojemann R., Swartz ., Richardson E. Spinal epidural abscess. N Engl J Med,. 293:463–468. 1975.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
2). Baltz M., Tate D., Glaser J. Lumbar facet joint infection associated with epidural and paraspinal abscess. Clin Orthop,. 339:109–112. 1997.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
3). Chevalier X., Marty M., Larget-Piet BJ. Klebsiella pneumonia septic arthritis of a lumbar facet joint. J Rheumatol,. 19:1817–1819. 1992.
4). Cook NJ., Hanrahan P., Song S. Paraspinal abscess following facet joint infection. Clin Rheumatol,. 18:52–53. 1999.
5). Crenshaw AH. Campbell' s Operative Orethopedics. 8th ed.Mosby Year Book;1992.
6). Halpin DS., and Gibson RD. Septic arthritis of a lumbar facet joint. J Bone Joint Surg, 69B-. 3:457–460. 1987.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
7). Heenan SD., and Britton J. Septic arthritis in a lumbar facet joint: a rare cause of an epidural abxcess. Neurora -diol,. 37:462–464. 1995.
8). Magee M., Kannangara S., Dennien B, et al. Paraspinal abscess complicating facet joint infection. Clin Nucl Med. 25:71–73. 2000.
9). Muffoletto AJ., Ketonen LM., Mader JT, et al. H ematoge -nous pyogenic facet joint infection. Spine,. 26:1570–1576. 2001.
10). Peris P., Brancos MA., Gratacos J, et al. Septic arthritis of spinal apophyseal joint. Spine, 17-. 12:1514–16. 1992.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
11). Roberts W. Pyogenic vertebral osteomyelitis of a lumbar facet joint with associated epidural abscess. Spine,. 13:948–952. 1988.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
12). Sapico FL., Montgomerie JZ. Pyogenic vertebral osteomyelitis; Report of nine cases and review of the liter -ature. Rev Infect Dis. 1:754–776. 1979.
13). Weinstein JN., Wiesel SW. The Lumbar Spine. W. B. Saunders Company;1990.
Fig. 1.
Preoperative plain radiographs Arrow points to the erosion of inferior articular process and narrowing of L3-4 facet joint.
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