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Hematogenous pyogenic facet joint infection

A J Muffoletto1, L M Ketonen, J T Mader

  • 1Department of Orthopaedics and Rehabilitation, University of Texas Medical Branch, Galveston, Texas 77555-0792, USA.

Spine
|July 20, 2001
PubMed
Abstract

Insights

Hematogenous pyogenic facet joint infections are rare but often underdiagnosed. Early diagnosis and treatment, including percutaneous drainage and antibiotics, improve outcomes, while severe cases require surgical intervention.

Area of Science:

  • Spine surgery
  • Infectious diseases
  • Radiology

Background:

  • Hematogenous pyogenic facet joint infections are rare, with limited data on incidence, presentation, and treatment.
  • Only 27 cases were previously documented, highlighting the need for further research.

Purpose of the Study:

  • To determine the incidence, clinical presentation, diagnostic values, imaging characteristics, and optimal treatment for these infections.
  • To combine institutional data with published cases for a comprehensive analysis.

Main Methods:

  • Retrospective review of cases treated at a single institution.
  • Inclusion of previously published cases to augment the dataset.
  • Analysis of clinical characteristics, laboratory values, imaging findings, and treatment responses.

Main Results:

  • Six cases (4%) identified out of 140 spinal infections. Average age 55, 97% lumbar spine involvement.
  • 25% developed epidural abscesses, 38% severe neurologic deficits. Staphylococcus aureus was common.
  • MRI accurately identified infections. Percutaneous drainage (85% success) showed higher, though not statistically significant, success than antibiotics alone (71%).

Conclusions:

  • Hematogenous pyogenic facet joint infection is rare, underdiagnosed, and can lead to epidural abscesses and neurologic deficits.
  • Percutaneous drainage with antibiotics may offer better outcomes than antibiotics alone for uncomplicated cases.
  • Immediate decompressive laminectomy is crucial for cases with epidural abscess and severe neurologic compromise.

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