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Case Reports
. 2012 Apr 2:2012:bcr0920114849.
doi: 10.1136/bcr.09.2011.4849.

Septic arthritis of unilateral lumbar facet joint with contiguous abscess, without prior intervention

Luke William Harries  1 , Roland Watura
Affiliations
Case Reports

Septic arthritis of unilateral lumbar facet joint with contiguous abscess, without prior intervention

Luke William Harries et al. BMJ Case Rep. .

Abstract

A 40-year-old female patient presented with persistent severe back pain radiating to the right leg, abdominal pain and constipation. Other clinical symptoms included nausea, vomiting and high-grade fever. Clinical examination showed generalised abdominal and lower back tenderness. There was no sensory loss or motor weakness in lower limbs, however investigations showed raised inflammatory markers. Radiographs of the lumbar spine and hip joint were normal. MRI revealed a septic arthritis of the right L3/4 facet joint, associated with a large abscess extending anteriorly to the right paraspinal muscles and posteriorly into the right posterolateral aspect of the epidural space in the central spinal canal, with moderate compression of the dural sac. Unlike any other reported similar case, this septic arthritis developed without prior medical intervention. The patient was treated successfully with ultrasound guided drainage of the facet joint/abscess and antibiotics.

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Conflict of interest statement

Competing interests None.

Figures

Figure 1
Figure 1
Anteroposterior lumbar spine x-ray–No abnormalities shown.
Figure 2
Figure 2
Lateral lumbar spine x-ray–No abnormalities shown.
Figure 3
Figure 3
MRI axial T1 fat sat GAD 2–Shows rim enhancement of the facet joint abscess.
Figure 4
Figure 4
MRI axial T1 fat sat GAD 4–Shows rim enhancement of the facet joint abscess.
Figure 5
Figure 5
MRI axial T1 fat sat GAD–Shows rim enhancement of the facet joint abscess and shows abscess extension into the epidural space, with resulting canal stenosis and displacement of the dural sac.
Figure 6
Figure 6
MRI axial T2 best large 2–Shows septic arthritis of the facet joint with extension anteriorly into the epidural space, compressing and displacing the dural sac. Extension posteriorly into the erector spinae muscles.
Figure 7
Figure 7
MRI axial T2 best large–Shows septic arthritis of the facet joint with extension anteriorly into the epidural space, compressing and displacing the dural sac. Extension posteriorly into the erector spinae muscles.
Figure 8
Figure 8
MRI axial T2 2–Shows septic arthritis of the facet joint with extension anteriorly into the epidural space, compressing and displacing the dural sac. Extension posteriorly into the erector spinae muscles.
Figure 9
Figure 9
MRI axial T2 3–Shows septic arthritis of the facet joint with extension anteriorly into the epidural space, compressing and displacing the dural sac. Extension posteriorly into the erector spinae muscles.
Figure 10
Figure 10
MRI cor T2 fat sat GAD 3 larger–Shows rim enhancement of abscess which extends into the adjacent muscle.
Figure 11
Figure 11
MRI cor T2 fat sat GAD 3–Shows rim enhancement of abscess which extends into the adjacent muscle.
Figure 12
Figure 12
MRI sag T2 best 2–Showing facet joint abscess with extension anteriorly into the epidural space, posteriorly into the erector spinae muscles.
Figure 13
Figure 13
MRI sag T2 best 3–Showing facet joint abscess with extension anteriorly into the epidural space, posteriorly into the erector spinae muscles.
Figure 14
Figure 14
MRI sag T2 best 4–Showing facet joint abscess with extension anteriorly into the epidural space, posteriorly into the erector spinae muscles.
Figure 15
Figure 15
MRI sag T2 best 5–Showing facet joint abscess with extension anteriorly into the epidural space, posteriorly into the erector spinae muscles.
Figure 16
Figure 16
MRI sag T2 best–Showing facet joint abscess with extension anteriorly into the epidural space, posteriorly into the erector spinae muscles.
Figure 17
Figure 17
MRI sag T2 fat sat best 2–Showing facet joint abscess with extension anteriorly into the epidural space, posteriorly into the erector spinae muscles.
Figure 18
Figure 18
MRI sag T2 fat sat best 3–Showing facet joint abscess with extension anteriorly into the epidural space, posteriorly into the erector spinae muscles.
Figure 19
Figure 19
Ultrasound demonstrating abscess collection in the deep soft tissues and muscle.
See this image and copyright information in PMC

References

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