J Korean Soc Spine Surg.  2006 Dec;13(4):299-305.

Iatrogenic Spinal Infection after Injection Therapy in Spine.

• Byun YS
• Kim HT
• Chang SA
• Lee SR
• Hwang DH
• Kim SH

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.

Keyword

Spine; Iatrogenic infection; Injection therapy

MeSH Terms

Abscess
Aging
Diabetes Mellitus
Discitis
Drainage
Epidural Abscess
Epidural Space
Humans
Immunocompromised Host
Incidence
Liver Diseases
Medical Records
Myositis
Paraspinal Muscles
Retrospective Studies
Risk Factors
Specialization
Spine*
Trigger Points

Figure

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  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.

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  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.

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