Hooten W Michael, Mizerak Andrew, Carns Paul E, Huntoon Marc A
Department of Anesthesiology and Psychiatry and Psychology, Mayo Clinic College of Medicine and Mayo Graduate School of Medicine, Rochester, Minnesota 55905, USA.
Pain Med. 2006 Jan-Feb;7(1):46-51. doi: 10.1111/j.1526-4637.2006.00088.x.
The primary objective is to document the first case report of discitis after a lumbar epidural corticosteroid injection. The second objective is to analyze the case report literature to identify clinical features and trends of patients with infectious complications after spinal injections.
Single case report. A MEDLINE and EMBASE literature search was conducted using key words from the names of commonly performed spinal procedures, including epidural corticosteroid, selective nerve root, transforaminal epidural, facet joint, and sacroiliac joint injections.
Pain medicine clinic at a tertiary medical center.
A 64-year-old man with an 8-year history of left lower extremity radicular pain and recurrent pulmonary infections was referred for a lumbar epidural corticosteroid injection. Six weeks following the injection, the patient returned with a 4-week history of worsening right-sided paraspinous pain without associated recurrent pneumonia. Magnetic resonance imaging revealed a right-sided L5-S1 disc extrusion with discitis and a right L5-S1 discectomy was performed. Cultures of disc material and blood showed growth of coagulase-negative Staphylococcus, and a transesophageal echocardiogram showed no evidence of endocarditis. The patient received 6 weeks of intravenous antibiotics and he had symptomatic recovery at 3-month follow-up.
Including our patient, the literature search identified 27 case reports of infectious complications. Similar clinical features and significant trends were evident in five categories including predisposing factors, symptom presentation, diagnostic evaluation, etiological organisms, and treatment outcomes.
The identified clinical features and trends could prove useful to the practitioner when an infectious complication is suspected or has occurred.
主要目的是记录腰椎硬膜外皮质类固醇注射后椎间盘炎的首例病例报告。次要目的是分析病例报告文献，以确定脊柱注射后感染并发症患者的临床特征和趋势。
单病例报告。使用常见脊柱手术名称中的关键词在MEDLINE和EMBASE数据库进行文献检索，这些手术包括硬膜外皮质类固醇注射、选择性神经根注射、经椎间孔硬膜外注射、小关节注射和骶髂关节注射。
三级医疗中心的疼痛医学诊所。
一名64岁男性，有8年左下肢神经根性疼痛和反复肺部感染病史，因腰椎硬膜外皮质类固醇注射前来就诊。注射后六周，患者因右侧椎旁疼痛加重4周复诊，无反复肺炎相关症状。磁共振成像显示右侧L5-S1椎间盘突出伴椎间盘炎，遂行右侧L5-S1椎间盘切除术。椎间盘组织和血液培养显示凝固酶阴性葡萄球菌生长，经食管超声心动图未显示心内膜炎迹象。患者接受了6周静脉抗生素治疗，3个月随访时症状缓解。
包括我们的患者在内，文献检索共识别出27例感染并发症的病例报告。在易患因素、症状表现、诊断评估、病原体和治疗结果这五个类别中，相似的临床特征和显著趋势明显。
当怀疑或发生感染并发症时，所确定的临床特征和趋势可能对从业者有用。
