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Isolated septic facet joints: an underdiagnosed distinct clinical entity
Maja Babic1, Hakan Ilaslan2, Nabin Shrestha1
1Infectious Disease Department, Cleveland Clinic, Cleveland, OH, USA.
Skeletal Radiology
|April 6, 2020
Summary
Isolated septic facet joints (ISFJ) are an underrecognized cause of epidural abscesses. These infections, often hematogenously seeded, frequently require surgical decompression, highlighting the need for prompt diagnosis.
Area of Science:
- Spine infections
- Infectious diseases
- Orthopedic surgery
Background:
- Septic facet joints (SFJ) are distinct from spondylodiscitis.
- Modern imaging reveals SFJ are not rare.
- Awareness of SFJ as a distinct clinical entity is increasing.
Purpose of the Study:
- To review a series of isolated septic facet joints (ISFJ).
- To compare ISFJ to spondylodiscitis.
- To raise awareness of ISFJ as a cause of epidural abscesses.
Main Methods:
- Retrospective review of 353 spine infection cases (2008-2017).
- Identified 152 septic facet joints via MRI.
- Focused on 62 ISFJ cases without spondylodiscitis.
Main Results:
- ISFJ predominantly affected males (61%), mean age 56.7 years.
- 85% of ISFJ cases had associated epidural abscesses (EDA).
- 95% of cases identified a pathogen, 81% had bacteremia; 7 iatrogenic cases required surgery.
Conclusions:
- Septic facet joints are a common, overlooked cause of EDA.
- Most SFJ are hematogenously seeded with bacteremia.
- Surgical decompression is often necessary due to EDA; iatrogenic SFJ carry high morbidity.
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