Iatrogenic Spinal Infection after Injection Therapy in Spine.

Young-Soo Byun; Hong-Tae Kim; Se-Ang Chang; Sung-Rak Lee; Dae-Hee Hwang; Sang-Hee Kim

doi:10.4184/jkss.2006.13.4.299

Journal List > J Korean Soc Spine Surg > v.13(4) > 1035732

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Byun, Kim, Chang, Lee, Hwang, and Kim: Iatrogenic Spinal Infection after Injection Therapy in Spine.

Original Article

Journal of Korean Spine Surg 2006;13(4):299-305.

Published online: 21 February 2006

DOI: https://doi.org/10.4184/jkss.2006.13.4.299

Iatrogenic Spinal Infection after Injection Therapy in Spine.

Young-Soo Byun, M.D., Hong-Tae Kim, M.D., Se-Ang Chang, M.D., Sung-Rak Lee, M.D., Dae-Hee Hwang, M.D., Sang-Hee Kim, M.D.

Department of Orthopaedic Surgery, Fatima Hospital, Daegu, Korea

Address reprint requests to Se Ang Chang, M.D. Department of Orthopaedic Surgery, Fatima Hospital 576-31 Sinamdong, Donggu, Daegu 701-600, Korea Tel: 82-53-940-7320, Fax: 82-53-954-7417, E-mail: fatimaos@unitel.co.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Designs

A retrospective study of clinical experience.

Objectives

To investigate and report the iatrogenic form of spinal infections that occur after injection therapy in the spine.

Summary of Literature Review

An iatrogenic infection after injection therapy in the spine is rarely reported to be a serious complication. However, an increase in the number of immunocompromised patients, the aging of the population, and particularly an increase in spinal procedureshave precipitated a rise in the incidence of spinal infections.

Materials and Method

Iatrogenic spinal infections occurred in 8 patients after various injection therapy in the spine, which included an epidural steroid injection or trigger point injection for various spinal conditions. The medical records and images of these patients regarding the clinical findings, risk factors, and treatments were analyzed.

Results

The pathologic conditions of the spinal infection were discitis in four patients with a concomitant infection in the epidural space and paraspinal muscles, an epidural abscess, and solitary muscular abscess or myositis in the other 3 patients. The systemic risk factors contributing to the infections were diabetes mellitus, metastatic cancer, and chronic liver disease in four patients. For treatment, intensive antibiotic therapy was applied to all patients. Six of the 8 patients underwent surgical drainage for abscesses and/or fusion to stabilize the infected segments. The infections were eventually controlled in all patients.

Conclusion

Iatrogenic pyogenic infections of the spine after injection therapy in the spine is a serious complication with regard morbidity and treatment. To avoid these serious complications, a specialist experienced in aseptic techniques should perform these spinal procedures, particularly in those patients with the risk factors.

Keywords: Spine, Iatrogenic infection, Injection therapy

REFERENCES

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Figures and Tables%

Fig. 1.

Case 7. A 35 years old female with disc herniation at L4-5, the initial radiograph (A) shows no narrowing of disc space. (B) Radiograph at 6 weeks after epidural steroid injections shows marked narrowing of disc space and blurring of end plates. (C) Good interbody fusion 17 months after anterior debridment and bone graft with internal fixation.

Fig. 2.

Case 7. Initial MRI (A) shows disc herniation at L4-5. 6 weeks after epidural steroid injections MRI shows low signal in the adjacent vertebral bodies at T1 weighted image (B) and high signal in adjacent vertebral bodies at enhanced image (C), sug-gesting discitis.

Table 1.

Summary of Cases.

No.	Age/Sex	Primary Diagnosis	Combined Disease	Injection Therapy	Blood Culture	Local Culture
1.	64/F	Degenerative	Hypertension	Epidural	Staph.	- -
		spondylolisthesis		injection	aureus
2.	73/F	Lumbar	Alcoholism &	Trigger point	E. Coli	E. Coli
		sprain	Chronic hepatitis	injection
3.	52/F	Metastatic	DM* &	Epidural	- -	Staph.
		carcinoma	Renal cell Ca.	catheterization		aureus
4.	63/F	Degenerative	Hypothyroidism	Epidural	- -	Coagul.(-)
		spondylolisthesis		injection		staph.
5.	80/F	Degenerative	Hypertension	Epidural	Staph.	- -
		spondylolisthesis		injection	aureus
6.	63/F	Degenerative	DM*	Trigger point	Negative	Staph.
		spondylolisthesis		injection		aureus
7.	35/F	Disc	- -	Epidural	Negative	Negative
		herniation		injection
8.	58/M	Lumbar	DM*	Trigger point	Staph	Staph.
		sprain		injection	aureus	aureus

^∗ : Diabetes mellitus

Table 2.

Summary of Cases.

No.	Infection Site	Infection Pathology	Surgery	F/U
1.	Lower lumbar	Myositis	- -	15 m
	paraspinal
2.	Lower lumbar	Myositis &	Incision &	18 m
	paraspinal	Abscess	drainage
3.	Upper lumbar	Epidural abscess	Laminectomy &	5 m
			drainage
4.	L4-5	Discitis &	PL^† fusion &	24 m
	Lower lumbar	Epidural infection	Int. fixation
5.	L4-5	Discitis &	- -	25 m
	Lower lumbar	Epidural infection
6.	Lower lumbar	Myositis &	Incison &	19 m
	paraspinal	Abscess	drainage
7.	L4-5	Discitis	Ant. fusion &	17 m
			Int. fixation
8.	L5-S1	Discitis &	Incison &	12 m
	Psoas muscle	Abscess	drainage

^† : Posterolateral

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