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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.
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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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