Particular Form of Septic Arthritis: Septic Arthritis of Facet Joint.
Michel-Batôt C, Dintinger H, Blum A, Olivier P, Laborde F, Bettembourg-Brault I, Pourel J, Loeuille D, Chary-Valckenaere I. Rheumatology Department, Brabois Teaching Hospital, CHU Brabois, 54000 Nancy, France.
Only about 40 cases of septic arthritis of the facet joints have been reported to date. We report 6 new cases including 2 at the cervical spine, which is rarely involved. Mean age was 61.5 years; there were 5 men and 1 woman. Spinal pain and stiffness, fever, and asthenia were the presenting manifestations. Laboratory tests consistently showed inflammation. Among classical risk factors for infection, only noninsulin-dependent diabetes was noted, in a single patient. Mean time to the diagnosis was 42 days.
Discitis, a far more common condition, was considered initially, and early radiographs were of limited diagnostic assistance. Radionuclide bone scans identified the site of the infection and served to look for other foci. Magnetic resonance imaging was effective in confirming the diagnosis at an early stage and in looking for local spread (muscles, epidural space, and disk). L3-L4 was involved in 3 patients, C4-C5 in 2, and L4-L5 in 1. Direct inoculation during mesotherapy sessions was the cause in 1 patient. Cultures of blood and needle biopsy samples were positive in all 6 cases; Staphylococcus aureus was the causative agent in 3 patients. The risk of local and systemic complications governs the prognosis of facet joint infection.
Of our 6 patients, 4 experienced complications: there was 1 case each of discitis, epidural infection, endocarditis, and septic arthritis of the acromioclavicular joint. Fatal multiple organ dysfunction occurred in 1 patient. In the other 5 patients, antimicrobial therapy and protection from weight-bearing for 3 months ensured a favorable outcome.
PMID: 18093863 [PubMed - as supplied by publisher]
Rev Rhum Engl Ed. 1997 Jun;64(6):386-95.
Rev Rhum Engl Ed. 1997 Dec;64(12):859-60.
Septic Arthritis Of Lumbar Facet Joints. A Review Of Six Cases. Ergan M, Macro M, Benhamou CL, Vandermarcq P, Colin T, L'Hirondel JL, Marcelli C.Rheumatology Department, Côte de Nacre Teaching Hospital, Caen, France.
Hematogenous infection of the facet joints by pyogenic organisms is exceedingly rare. We report six cases of lumbar facet joint septic arthritis due to hematogenous spread of a pyogenic organism. A review of the literature identified ten anecdotal reports of similar cases. An analysis of these 16 cases showed that the diagnosis was based mainly on imaging study findings and that clinical data failed to discriminate between facet joint septic arthritis and infectious discitis. Increased uptake on the radionuclide bone scan was an early finding and the pattern of uptake was different from that seen in discitis.
Computed tomography was the investigation that best delineated the facet joint lesions. Magnetic resonance imaging of the lumbar spine was superior over computed tomography in demonstrating spread of the infection to the epidural space and/or soft tissues and in some instances demonstrated enhancement of the infected facet joint on T1 images after gadolinium injection. Aspiration of the facet joint under fluoroscopic guidance was required only when blood cultures were negative or when the diagnosis of the septic nature of the arthritis was in doubt. Blood cultures yielded a Staphylococcus aureus in the six cases in our series. Appropriate antimicrobial therapy was successful in most cases. In our series, four of the six patients had posterior epiduritis, pyomyositis, or an abscess in the paraspinal muscles or psoas muscle, suggesting that some epidural infections or psoas muscle abscesses believed heretofore to be primary may in fact be complications of facet joint septic arthritis. Facet joint septic arthritis is a new aspect of pyogenic spinal infections that deserves to be considered in patients with febrile spinal syndromes not explained by discitis. PMID: 9513611 [PubMed - indexed for MEDLINE]
J Spinal Disord Tech. 2003 Jun;16(3):285-7.
Delayed Presentation Of Septic Arthritis Of A Lumbar Facet Joint After Diagnostic Facet Joint Injection. Orpen NM, Birch NC.
Department of Trauma and Orthopaedics, WycombeGeneralHospital, High Wycombe, UK.
We report the case of a 46-year-old, otherwise healthy, man with chronic lower back pain and no evidence of nerve root compression who underwent diagnostic facet joint injections to assist in establishing where his pain sources were located and to try to help his spinal rehabilitation program. He presented with a facet joint infection 2 months after injection, in a manner that was indistinguishable from an acute intervertebral disc herniation. The diagnosis was confirmed on magnetic resonance imaging, and he was successfully treated with surgical debridement and antibiotics. Septic arthritis of a lumbar facet joint with an associated paraspinal abscess is a rare complication of facet joint infiltration with only two similar cases reported in the literature. We propose that this diagnosis be considered in patients who have undergone diagnostic facet joint injection who subsequently deteriorate with back and leg pain without another apparent cause.PMID: 12792344 [PubMed - indexed for MEDLINE]
Pain Med. 2006 Jan-Feb;7(1):52-6.
Septic Facet Joint Arthritis After A Corticosteroid Facet Injection.
Weingarten TN, Hooten WM, Huntoon MA. Department of Anesthesiology, MayoClinicCollege of Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota55905, USA.
Lumbar facet joint injections are commonly employed in the treatment of low back pain and are considered to be relatively safe with few known complications. We report the case of septic facet arthritis following a periarticular facet injection in a patient with recurrent urinary tract infections. The literature is reviewed to identify epidemiological and clinical features of patients in whom septic facet arthritis developed after lumbar facet injection. The diagnosis of iatrogenic septic facet arthritis is often delayed because neurologic and constitutional signs and symptoms develop slowly. Serologic nonspecific markers of infection and appropriate imaging studies may be more sensitive for the early diagnosis of septic facet arthritis. Recalcitrant or worsening back pain after facet injections should prompt an investigation to rule out infectious causes. PMID: 16533197 [PubMed - indexed for MEDLINE]
Semin Arthritis Rheum. 2006 Apr;35(5):272-83.
Spontaneous Pyogenic Facet Joint Infection.
Narváez J, Nolla JM, Narváez JA, Martinez-Carnicero L, De Lama E, Gómez-Vaquero C, Murillo O, Valverde J, Ariza J. Rheumatology Department, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain.
OBJECTIVE: To analyze the clinical features, approaches to management, and outcome of spontaneous pyogenic facet joint infection (PFJI) in adults.
PATIENTS AND METHODS: Case series of 10 adults with microbiologically proven PFJI diagnosed during a 10-year period in a teaching hospital, plus a review of 32 additional cases previously reported (PubMed 1972 to 2003). Patients with prior spinal instrumentation or surgery and injection drug users were excluded. Only cases that were sufficiently detailed to be individually analyzed were included. These 32 cases, together with our 10 patients, form the basis of the present analysis.
RESULTS: PFJI represented nearly 20% of all spontaneous pyogenic spinal infection diagnosed in our hospital during a 10-year period. This data suggest that PFJI is more common than was previously thought. This data suggest that PFJI is more common than was previously thought. Of the 42 patients with PFJI, 26 (62%) were men and 16 (38%) were women, with ages ranging from 20 to 86 years (mean age, 59+/-15 years); 55% of patients were older than 60 years. The most common location of infections was the lumbosacral region (86%). All patients presented with severe back pain; fever was noted in 83% of the cases and neurological impairment in nearly 48%. In 38% of patients a systemic predisposing factor for infection was present; the most common conditions were diabetes mellitus, malignancies, and alcoholism.
In almost 36% of cases, one or more concomitant infectious processes due to the same microorganism was found, mainly arthritis, skin and soft-tissue infections, endocarditis, and urinary tract infections. Staphylococcus aureus was the most common etiologic microorganism (86% of cases). Bacteremia was documented in 81% of the cases. The diagnosis of PFJI was based mainly on imaging study findings. Paraspinal and/or epidural extension was frequent (81% of cases), but its presence did not indicate a worse prognosis. Medical treatment alone was usually successful. The overall prognosis of PFJI was good, with a mortality rate of only 2%. The great majority of patients were cured without functional sequelae.
CONCLUSION: Incidence data from our institution reveal that PFJI is not a rare condition, representing approximately 20% of all pyogenic spinal infections. This entity should be considered in the differential diagnosis of patients with low back pain, especially in the presence of fever, whatever the patient's immunological status. PMID: 16616150 [PubMed - indexed for MEDLINE]
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