Septic Arthritis of Lumbar Facet Joints Without Predisposing Infection

Abstract

Septic arthritis of a lumbar facet joint is a rare clinical entity and most articles have reported a single case. There have been few studies that have evaluated the clinical and imaging features of septic arthritis of lumbar facet joints. The clinical data of 5 patients diagnosed with septic arthritis of lumbar facet joints were retrospectively studied. The average age of 5 patients was 73.6 years. All patients had elevated temperature at admission (37.7 degrees C). Leukocyte count was tested in all 5 patients and was elevated in only 2 patients. Erythrocyte sedimentation rate and C-reactive protein were examined and were elevated in all 5 cases. Magnetic resonance imaging was accurate in identifying the septic joint and associated abscess formation. All patients were treated with bed rest and received intravenous antibiotics for an average of 33.3 days. Four of 5 patients had positive outcomes with full recoveries and no evidence of recurrent infections. One patient exhibited evidence of recurrent infection and required open facet arthrotomy and paraspinal muscle debridement after intravenous administration of antibiotics. Septic arthritis of the lumbar facet joint is a rare cause of low back pain. It is important to ascertain the diagnosis at the earliest possible stage and to start intravenous antibiotics therapy as soon as possible. Magnetic resonance imaging is quite a sensitive modality for identifying infection of the lumbar facet joint. Familiarity with its clinical symptoms and radiographic features is necessary to avoid misdiagnosis of this condition.

A Rare Case of Thoracic Pyogenic Facet Joint Infection

“…The pathophysiology of the epidural abscess is explained because of the narrow facet joint cavity, which facilitates the easy spread of infection to the epidural space (by rupture of the ventral aspect of the joint capsule) and to the paravertebral muscles (by rupture of the posterior aspect of the joint capsule) [1,10]. Another mechanism of physiopathology of hematogenous spread to the extra facet has been reported in some studies [4,5]. For example, Muffoletto et al stated that hematogenous spread occurs via the branches of the posterior intercostal vessels [4].…”

“…Septic arthritis of the facet joint is a rare condition. Four retrospective reviews of case reports in the literature found that septic arthritis of the facet joint causes 4%-20% of pyogenic spinal infections, 86%-97% of which occur in the lumber spine [3][4][5][6]. It has been reported that there are some risk factors that predispose to infection in PFJI patients, but Narváez et al have stated that more than 60% of PFJI patients show no systematic risk factors, indicating that spontaneous PFJI can also affect immune-competent patients, as was seen in our case [3].…”

“…While most cases are thought to occur via hematogenous spread [3,4], there are some case reports in the literature where septic arthritis of the facet joint resulted from iatrogenic causes, including steroid injection and epidural catheterization [7][8][9]. These infections can also occur secondary to the spread of adjacent infections, such as spondylodiscitis, epidural or paraspinal abscess, psoas muscle abscess, and other intra-abdominal infections [5]. Based on MRI findings, we determined our case did not occur following spondylodiscitis.…”

“…The facet joint destruction can be seen on simple X-ray and CT images for about 1 month and 1 week after the onset, respectively. MRI is useful for early definitive diagnosis [4,5]. It has been reported that signal changes in soft tissue appear 2 days after onset, but it often takes about 1 week to capture obvious changes [12].…”

Pyogenic and non-pyogenic spinal infections: emphasis on diffusion-weighted imaging for the detection of abscesses and pus collections

“…[32][33][34][35] This is another important route of infection resulting in epidural/ paraspinal abscesses. Facet joint infection is often haematogenous but also caused by epidural anaesthesia and spinal procedures.…”