Spinal Epidural Abscess with Pyogenic Arthritis of Facet Joint Treated with Antibiotic-Bone Cement Beads - A Case Report -

Abstract

Most epidural abscesses are a secondary lesion of pyogenic spondylodiscitis. An epidural abscess associated with pyogenic arthritis of the facet joint is quite rare. To the best of our knowledge, there is no report of the use of antibiotic-cement beads in the surgical treatment of an epidural abscess. This paper reports a 63-year-old male who sustained a 1-week history of radiating pain to both lower extremities combined with lower back pain. MRI revealed space-occupying lesions, which were located in both sides of the anterior epidural space of L4, and CT scans showed irregular widening and bony erosion of the facet joints of L4-5. A staphylococcal infection was identified after a posterior decompression and an open drainage. Antibiotic- bone cement beads were used as a local controller of the infection and as a spacer or an indicator for the second operation. An intravenous injection of anti-staphylococcal antibiotics resolved the back pain and radicular pain and normalized the laboratory findings. We point out not only the association of an epidural abscess with facet joint infection, but also the possible indication of antibiotic-bone cement beads in the treatment of epidural abscesses.

Catheter-based Minimally Invasive Evacuation of Extensive Spinal Epidural Abscess: A Technical Report

“…However, the appearance of a synovial cyst on CT is not typically associated with bone erosion but it may present with sclerosis, gas or calcifications in the cyst capsule [14]. In contrast to synovial cysts, bone erosion is reported frequently with PFJ [6, 15]. On T2-weighted MRI scans, PFJ demonstrates widening of the facet joint space as well as erosion and swelling (Figure 2D).…”

First report on treating spontaneous infectious spondylodiscitis of lumbar spine with posterior debridement, posterior instrumentation and an injectable calcium sulfate/hydroxyapatite composite eluting gentamicin: a case report

“…Other groups have used antibiotic bone cement beads [21], a combination of antibiotic-impregnated BGS and autograft [22] or bioactive glass S53P4 [23]. In our opinion, the advantage of the injectable calcium sulfate/hydroxyapatite composite plus gentamicin is the high local concentration of gentamicin at the desired location [24], the complete resorption of the BGS, and its osteoconductivity.…”

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

“…Regarding dissemination of abscess in the facet joint of the vertebrae to the epidural space, Lee et al [ 10 ] reported that good outcome could be achieved using antibiotics cement beads. Our patient was treated by surgical debridement of the abscess followed by intravenous and oral antibiotics, and good outcome was obtained during the follow-up period.…”

“…Most pyogenic arthritis of the facet joint is considered to be secondary to spinal osteomyelitis of the vertebral body. Nonetheless, in some cases bacterial invasion of the facet joint by hematogenous dissemination without associated vertebral body osteomyelitis have been reported [ 10 ]. Based on these experiences, direct bacterial invasion is thought to co-exist with secondary dissemination of osteomyelitis in the vertebral body.…”