Hematogenous pyogenic facet joint infection of the subaxial cervical spine- A report of two cases and review of the literature

Two cases of hematogenous, pyogenic, subaxial cervical facet joint infectio n are reported, and the literature is reviewed. Infection of the cervical f acet joint is a rarely diagnosed condition; only one case has been reported in the literature. Lumbar facet joint infections are also rare but more co mmonly reported. Approximately one fourth of facet joint infections in the lumbar spine are complicated by epidural abscess formation, which can lead to a neurological deficit. Because of the paucity of reports on cervical fa cet joint infections, the clinical characteristics of this entity are not w ell known. Both patients presented with an acute onset of unilateral neck pain that ra diated into the ipsilateral shoulder. Frank radicular pain was initially ab sent. Unilateral upper-extremity motor weakness that was attributed to asso ciated epidural abscess or granulation tissue formation was also demonstrat ed in both patients. Leukocyte count and erythrocyte sedimentation rate wer e elevated in both cases. Magnetic resonance imaging was necessary to obtai n an accurate diagnosis. Staphylococcus aureus was identified as the offend ing pathogen in both cases. Decompressive surgery and antibiotic therapy we re required to cure the condition. One patient recovered completely and the other sustained a permanent motor deficit. Hematogenous cervical facet joint infection is a rare clinical entity that has many characteristics in common with the more-common lumbar homolog. All three reported cases, however, have been complicated by epidural abscess o r granulation tissue formation that has led to a neurological deficit. This finding suggests that a facet joint infection in the cervical spine may ha ve a less benign clinical course than that in the lumbar spine.