Babic Maja, Ilaslan Hakan, Shrestha Nabin, Simpfendorfer Claus S
Infectious Disease Department, Cleveland Clinic, Cleveland, OH, USA.
Imaging Institute, Cleveland Clinic, Cleveland, OH, USA.
Skeletal Radiol. 2020 Aug;49(8):1295-1303. doi: 10.1007/s00256-020-03434-8. Epub 2020 Apr 4.
We review a series of isolated septic facet joints (ISFJ) that present as a distinct clinical entity compared with spondylodiscitis. We aim to raise awareness that septic facet joints are not a rare entity in the era of modern imaging.
We reviewed 353 patients with confirmed spine infections from 2008 to 2017. Of the 353 cases, there were 152 septic facet joints based on MR imaging. Sixty-two presented as ISFJ without evidence of spondylodiscitis and were reviewed.
Patients were predominantly male 38/62 (61%). The mean age was 56.7 years. Onset of back pain was more acute compared with spondylodiscitis and usually unilateral. The distribution was as follows: 6 cervical, 12 thoracic, and 44 lumbar facets. The majority of ISFJ, 53/62 (85%), were associated with an epidural abscess (EDA) 53/62. The cervical and thoracic EDA required surgical decompression more frequently than lumbar; 100%, 75%, and 53% respectively. Pathogen was identified in 59/62 (95%) cases. Most cases were associated with bacteremia 50/62 (81%). Seven ISFJ were introduced iatrogenically. All iatrogenic ISFJ required surgical decompression.
Septic facet joints are not rare, but frequently overlooked as the origin of an epidural abscess. The majority of cases are hematogenously seeded and associated with bacteremia. Surgical decompression is frequently required secondary to the high incidence of associated epidural abscess. Iatrogenic septic facet joints are rare but associated with significant morbidity. From a clinical standpoint, it is helpful to delineate the origin of EDA as either secondary to spondylodiscitis or SFJ.
我们回顾了一系列孤立性化脓性小关节（ISFJ）病例，与脊椎椎间盘炎相比，它是一种独特的临床实体。我们旨在提高人们的认识，即在现代影像学时代，化脓性小关节并非罕见病症。
我们回顾了2008年至2017年确诊的353例脊柱感染患者。在这353例病例中，基于磁共振成像有152例为化脓性小关节。其中62例表现为孤立性化脓性小关节，无脊椎椎间盘炎证据，并进行了回顾分析。
患者以男性为主，38/62（61%）。平均年龄为56.7岁。与脊椎椎间盘炎相比，背痛发作更为急性，且通常为单侧。分布情况如下：颈椎小关节6例，胸椎小关节12例，腰椎小关节44例。大多数孤立性化脓性小关节，53/62（85%），与硬膜外脓肿（EDA）相关，共53/62例。颈椎和胸椎硬膜外脓肿比腰椎更常需要手术减压；分别为100%、75%和53%。62例中有59例（95%）鉴定出病原体。大多数病例与菌血症相关，50/62（81%）。7例孤立性化脓性小关节是医源性的。所有医源性孤立性化脓性小关节均需要手术减压。
化脓性小关节并不罕见，但常被忽视作为硬膜外脓肿的起源。大多数病例是血行播散性的，并与菌血症相关。由于相关硬膜外脓肿的高发病率，经常需要手术减压。医源性化脓性小关节很少见，但与严重的发病率相关。从临床角度来看，明确硬膜外脓肿是继发于脊椎椎间盘炎还是小关节感染是有帮助的。
