Pyogenic Arthritis of the Facet Joint with Concurrent Epidural and Paraspinal Abscess: A Case Report

Abstract

Pyogenic arthritis of lumber spinal facet joints is an extremely rare condition. There are only 40 reported cases worldwide. Most cases were associated with history of paravertebral injection, which was not found in our patient. At the time of hospital admission, he had no abnormal magnetic resonance image findings. Two weeks later, he developed pyogenic facet joint arthritis associated with paravertebral and epidural abscess. This report is the first to describe delayed presentation of pyogenic arthritis associated with paravertebral abscess and epidural infection.

Izolowane zapalenie stawu międzykręgowego jako rzadka przyczyna ostrego i przewlekłego zespołu bólowego odcinka lędźwiowo-krzyżowego kręgosłupa – opis przypadku i przegląd literatury.

“…It is estimated that pain located at the level involved in the pathological process is experienced by approx. 90–97% of patients with facet joint arthritis [7–9]. Our patient also suffered from a local pain on the right side, exacerbating while bending the body sideways and backwards, which is also a characteristic manifestation of a one-sided facet joint arthritis.…”

“…47%, and fever in 50–70% of patients [7–9]. Our patient presented all typical symptoms of the disease: sudden and acute pain in the lumbar spine, passing into chronic, which was not relieved or even increased after resting.…”

“…Since then, only 40 documented cases of facet joint arthritis have been described worldwide (pyogenic/septic facet joint arthritis) [7]. The disease usually occurs on one side and at a single level [8].…”

“…The disease usually occurs on one side and at a single level [8]. Most of the cases are associated with previous injections of steroids in the perispinal area; the disease may also develop secondary to purulent infections within a vertebral body [7,8]. Recently, it has been noticed that over half of the cases of facet joint arthritis are related to a hematogenous spread [9], which probably occurred in the case of our patient, who had not undergone any previous intraarticular injections or inflammatory processes of other spinal structures that could be a source of the infection.…”

Idiopathic septic arthritis of a lumbar facet joint associated with paraspinal abscess

“…Two possible routes for the spread of the infection have been proposed. The majority of cases (72%) spread haematologically from another source 6 12. There is no clear evidence of an exact pathological process.…”