Hematogenous pyogenic facet joint infection

Study Design. Retrospective. Objectives. To determine the incidence, clinical presentation, diagnostic l aboratory values, imaging characteristics, and optimal treatment of hematog enous pyogenic facet joint infections. Summary of Background Data. There are 21 documented cases of hematogenous p yogenic facet joint infections. Data regarding incidence, clinical presenta tion, diagnosis, and treatment response are incomplete because of the pauci ty of reported cases. Methods. This is a retrospective study of all cases Of hematogenous pyogeni c facet joint infection treated at one institution. Data from previous publ ications were combined with the present series to identify, pertinent clini cal characteristics and response to treatment. Results. A total of six cases (4%) of hematogenous pyogenic facet joint inf ection were identified of 140 cases of hematogenous pyogenic spinal infecti on at our institution. Combining all reported cases reveals the following: The average patient age is 55 years. Ninety-seven percent of cases occur in the lumbar spine. Epidural abscess formation complicates 25% of the cases of which 38% develop severe neurologic deficit. Erythrocyte sedimentation r ate and C-reactive protein are elevated in all cases. Staphylococcus aureus is the most common infecting organism. Magnetic resonance imaging is accur ate in identifying the septic joint and associated abscess formation. Percu taneous drainage of the involved joint has a higher rate of success (85%) t han treatment with antibiotics alone (71%), but the difference is not signi ficant (P = 0.37). Conclusions. Hematogenous pyogenic facet joint infection is a rare but unde rdiagnosed clinical entity. Facet joint infections may be complicated by ab scess formation in the epidural space or in the paraspinal muscles. Uncompl icated cases treated with percutaneous drainage and antibiotics may fare be tter than those treated with antibiotics alone. Cases complicated by an epi dural abscess and severe neurologic deficit should undergo immediate decomp ressive laminectomy.