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Iatrogenic (para-) spinal abscesses and meningitis following injection therapy for low back pain

C Gaul1, B Neundörfer, M Winterholler

  • 1Klinik und Poliklinik für Neurologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany Klinik und Poliklinik für Neurologie, Martin-Luther-Universität, Germany Neurologische Klinik, Krankenhaus Rummelsberg, Germany.

Pain
|June 28, 2005
PubMed

Insights

Repeated spinal injections for low back pain, though rare, can lead to serious infections like meningitis. These procedures, involving analgesics and steroids, pose a risk of bacterial inoculation, potentially causing severe neurological complications.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Pain Management

Background:

  • Low back pain is commonly managed with paraspinal injections of analgesics and steroids.
  • Infectious complications from these injections are infrequent but carry significant patient risk.

Purpose of the Study:

  • To investigate the association between previous spinal injection history and community-acquired purulent meningitis.
  • To determine the incidence and causative organisms of meningitis following spinal interventions.

Main Methods:

  • Prospective analysis of patients with community-acquired purulent meningitis over an 8-year period (1992-2000).
  • Detailed review of patient medical histories, focusing on prior paravertebral, facet-joint, peridural, or spinal injections.
  • Cerebrospinal fluid (CSF) analysis for bacterial identification.

Main Results:

  • Eight out of 128 patients (6.25%) had received spinal injections 2-21 days prior to meningitis diagnosis.
  • Staphylococcus aureus and coagulase-negative staphylococci were identified in the CSF of six patients.
  • One patient died, and three survived with neurological sequelae.

Conclusions:

  • Repeated spinal injections with analgesics and corticosteroids increase the risk of parameningeal bacterial inoculation.
  • These injections can lead to paraspinal, spinal, and epidural abscesses or meningitis.
  • While rare, these complications represent a notable proportion of community-acquired central nervous system infections.

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