Abstract
Introduction
Septic arthritis of a facet joint (SAFJ) is a relatively rare medical entity and the lumbar segment is its most frequent location. Although unusual, a spinal epidural abscess (SEA) can occur as a complication of SAFJ and possibly damage the spinal cord.
Case presentation
A 53-year-old woman presented with acute right dorsal pain, fever, loss of sphincters control, and paraparesis without causal factor. Forty-eight hours after the symptoms started, imaging revealed a thoracic posterior epidural collection causing compression of the spinal cord and features suggestive of septic arthritis of right T5-T6 facet joint. She underwent an urgent laminectomy and drainage of the abscess. Both blood and abscess cultures isolated Staphylococcus aureus. A diagnosis of complete paraplegia grade A of the ASIA (American Spinal Injury Association) Impairment Scale (AIS) with neurologic level T10 was made 5 days after surgery. She took 3 months of an intensive rehabilitation program at our Physical and Rehabilitation Medicine ward. With an unexpected favorable evolution, both neurological and functional, she was discharged with an incomplete paraplegia AIS D and functionally independent in all tasks.
Discussion
This case reveals an infrequent medical condition on a rarely affected spinal segment. An early diagnosis and proper treatment of SAFJ and SEA are of major importance to avoid severe related consequences. Patients with spinal cord injury with severe neurological deficits due to these conditions greatly benefit from an interdisciplinary rehabilitation program to improve neuromotor and functional status.
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References
Mas-Atance J, Gil-García MI, Jover-Sáenz A, Curià-Jové E, Jové-Talavera J, Charlez-Marco A, et al. Septic arthritis of a posterior lumbar facet joint in an infant: a case report. Spine (Philos Pa 1976). 2009;34:E465–E468. https://doi.org/10.1097/BRS.0b013e3181a4e64b.
Huguet S, Ibáñez N, Bernaus M, Font-Vizcarra L. Acute medullar compression secondary to a septic arthritis of a thoracic facet joint: a case report and review of literature. Spinal Cord Ser Cases. 2018;4:80. https://doi.org/10.1038/s41394-018-0117-0.
Setoue T, Nakamura JI. A rare case of thoracic pyogenic facet joint infection. Case Rep. Orthop. 2019;2019:8252986. https://doi.org/10.1155/2019/8252986.
Rhyu KW, Park SE, Ji JH, Park I, Kim YY. Pyogenic arthritis of the facet joint with concurrent epidural and paraspinal abscess: a case report. Asian Spine J. 2011;5:245–9. https://doi.org/10.4184/asj.2011.5.4.245.
Harries LW, Watura R. Septic arthritis of unilateral lumbar facet joint with contiguous abscess, without prior intervention. BMJ Case Rep. 2012;2012:bcr0920114849 https://doi.org/10.1136/bcr.09.2011.4849.
Rosc-Bereza K, Arkuszewski M, Ciach-Wysocka E, Boczarska-Jedynak M. Spinal epidural abscess: common symptoms of an emergency condition. A case report. Neuroradiol J. 2013;26:464–8. https://doi.org/10.1177/197140091302600411.
Narváez J, Nolla JM, Narváez JA, Martinez-Carnicero L, De Lama E, Gómez-Vaquero C, et al. Spontaneous pyogenic facet joint infection. Semin Arthritis Rheum. 2006;35:272–83. https://doi.org/10.1016/j.semarthrit.2005.09.003.
Lopes Correia B, Diniz SE, Lopes da Silva E, Rodrigues-Pinto R. Septic arthritis of the lumbar facet joint presenting as spontaneous bacterial peritonitis: a rare case requiring surgical intervention. Eur J Orthop Surg Traumatol. 2020;30:175–8. https://doi.org/10.1007/s00590-019-02527-y.
Sendi P, Bregenzer T, Zimmerli W. Spinal epidural abscess in clinical practice. QJM. 2008;101:1–12. https://doi.org/10.1093/qjmed/hcm100.
Ogura T, Mikami Y, Hase H, Mori M, Hayashida T, Kubo T. Septic arthritis of a lumbar facet joint associated with epidural and paraspinal abscess. Orthopedics. 2005;28:173–5.
Doita M, Nabeshima Y, Nishida K, Fujioka H, Kurosaka M. Septic arthritis of lumbar facet joints without predisposing infection. J Spinal Disord Tech. 2007;20:290–5. https://doi.org/10.1097/01.bsd.0000211285.91271.b3.
Scivoletto G, Tamburella F, Laurenza L, Torre M, Molinari M. Who is going to walk? A review of the factors influencing walking recovery after spinal cord injury. Front Hum Neurosci. 2014;8:141. https://doi.org/10.3389/fnhum.2014.00141.
Acknowledgements
We would like to express our thanks to Pedro Alves and Sofia Amante for the help and information regarding the imagiological point of view.
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Plancha da Silva, T., Amaral Silva, M., Santos Boaventura, S. et al. Spinal cord disorder due to spinal epidural abscess secondary to thoracic facet joint septic arthritis—a rare case with a surprising evolution. Spinal Cord Ser Cases 6, 102 (2020). https://doi.org/10.1038/s41394-020-00353-7
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DOI: https://doi.org/10.1038/s41394-020-00353-7
