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

Abstract

SUMMARYA 48-year-old woman presented with a 1-month history of severe lower back pain on a background of 24 h of mild fever and general tiredness with an associated right-sided foot drop. Five weeks after the onset and with no improvement in symptoms in spite of analgesia and physiotherapy, the patient had a lumbar spine MRI which demonstrated a collection extending from the facet joints of L5 and L6 to the iliacus muscle on the right. A CT-guided aspiration was performed with a lengthy hospital stay for intravenous antibiotic treatment. The culture and sensitivity study of the aspirate isolated Streptococcus pneumoniae. BACKGROUND

Acute medullar compression secondary to a septic arthritis of a thoracic facet joint: a case report and review of literature

“…Clinical signs and symptoms can vary between patients, and may resemble other pathologies such as spondylodiscitis [3,5,8,9] or pyelonephritis [6,8]. SAFJ generally presents as a unilateral back pain with often radiation to the flank or buttocks [2,3,6,8]. SAFJ seems to present with more acute and severe symptoms in early stages than spondylodiscitis [3].…”

“…There are only three more cases described in the literature with SAFJ in the thoracic spine [3,7,10]. Diabetes mellitus and other immunosuppressive diseases such as chronic liver disease, alcoholism or corticosteroid therapy have been described as risk factors to develop SAFJ [2,3,[6][7][8]. There have been cases of iatrogenic infection after invasive procedures like epidural injection, acupuncture or spinal surgery [3][4][5][6]11].…”

“…SAFJ is most frequently localised in the lumbar segment (86-97%) [3,5,6]. Many fewer cases are described for the cervical or thoracic vertebrae.…”

“…It can begin with very mild symptoms and could be very similar to spondylodiscitis. According to the literature, about 1 month is the average delay between symptoms and diagnosis of SAFJ [2,3,6,7]. Fever is present at the beginning of symptoms in 60-80% of the cases [2,3,7].…”

New and unusual causes of foot drop

“…These include diseases affecting the central nervous system, trauma, diseases affecting the peripheral nervous system and diseases or trauma affecting the muscle and tendon. Many reasons have been reported such as ganglion cyst in the proximal tibiofibular joint [3], motor cortex contusion [4], long-term lead intoxication [5], tight application of compression bandage [6,7], after lateral decubitus position [8] following dislocation reduction after total hip arthroplasty and gluteal haematoma [9,10], a complication of disc surgery [11], peripheral nerve entrapment [12,13], poorly administered injections (14], sciatic nerve pressure, piriformis syndrome [15], knee dislocations [16], following spinal and spinoepidural anaesthesia [17], paraspinal abscess [18], myopathies [19], neuropathic demyelinisation, hereditary neuropathies [20], popliteal artery aneurism [21], stroke [22,23], neuromuscular diseases [24,25], degenerative lumbar spinal diseases [26], gluteal compartment syndrome [27], decompression in burns [28], parasitic diseases such as neuro schistomiasis [29], after lower extremity compartment syndrome [30], and after total knee prosthesis [31].…”