J Korean Soc Spine Surg.  2003 Jun;10(2):196-201. 10.4184/jkss.2003.10.2.196.

Pyogenic Arthritis and Paraspinal Abscess Following Facet Joint Steroid Injection: A Case Report

• Lee JC
• Doh HW
• Cho YI
• Kim KJ
• Kim YI
• Shin BJ

• KMID: 2003218
• DOI: http://doi.org/10.4184/jkss.2003.10.2.196

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.

Keyword

Pyogenic facet joint infection; Paraspinal intramuscular abscess; Facet joint injection

MeSH Terms

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*
Anti-Bacterial Agents

Figure

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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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  Fig. 2. CT scan after contrast enhancement A. Right L3-4 facet joint was partially destructed and connected to the paraspinal intramuscular abscess B. Intramuscular paraspinal abscess at L4-5 facet joint level.

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  Fig. 3. MR images A. Paraspinal intramuscular abscess showed high signal intensity in T2 sagittal images. B. Direct connection between right L3-4 facet joint and paraspinal abscess noted. C. Intramuscular paraspinal abscess at L4-5 facet joint level.

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