Maehara Haruka, Sano Toshihiro, Yanagawa Yuki, Hashimoto Kyuichi, Tadokoro Nobuaki
Department of Orthopaedic Surgery, Kochi Prefectural Hata Kenmin Hospital, 3-1 Yoshina, Yamana-cho, Sukumo, Kochi 788-0785, Japan.
Department of Orthopaedic Surgery, Susaki Kuroshio Hospital, 4-30, Midorimachi, Susaki, Kochi 785-0036, Japan.
Case Rep Orthop. 2021 Apr 22;2021:5544126. doi: 10.1155/2021/5544126. eCollection 2021.
Pyogenic facet joint infection (PFJI) is a relatively rare spinal infection. Clinical suspicion of this condition is a key for diagnosis. We report a case of PFJI which required decompression surgery for severe neurological dysfunction. The patient was a 44-year-old woman who had a previous history of orthotic therapy for idiopathic scoliosis. The patient was admitted to our hospital with a history of two days of high fever and severe low back pain. There was no neurologic deficit, and blood tests revealed high levels of inflammatory markers. There was a slight amount of fluid that had collected at L4/5 facet joint in lumbar MRI. She was admitted for examination and treatment of fever of unknown origin and low back pain. Antibiotic treatment started the day after hospitalization since the first report of the blood culture taken upon admission tested positive to gram-positive cocci. As low back pain and fever persisted, an MRI was taken again on the fifth day of hospitalization. Repeated MRI showed fluid extension from the left facet joint to paravertebral muscles and epidural space. She was diagnosed with PFJI, and facet joint puncture was performed. At this time, it became clear that she had foot drop on the right, the contralateral side of the PFJI. She underwent irrigation, debridement, and partial laminectomy. Methicillin-sensitive Staphylococcus aureus (MSSA) was detected in blood cultures at the time of hospitalization, in the puncture fluid and tissue collected during surgery. The patient recovered completely from foot drop after the operation and a three-month course of antibiotics. As the imaging findings may be inadequate in the early stages of onset and PFJI potentially causes neurologic deficit such as foot drop, neurological findings need to be carefully observed even after hospitalization and one should reexamine the MRI if symptoms or clinical findings did not improve or were aggravated.
化脓性小关节感染（PFJI）是一种相对罕见的脊柱感染。临床怀疑这种情况是诊断的关键。我们报告一例因严重神经功能障碍需要减压手术的PFJI病例。患者为一名44岁女性，既往有特发性脊柱侧弯的矫形治疗史。患者因高热和严重腰痛两天入院。无神经功能缺损，血液检查显示炎症标志物水平升高。腰椎MRI显示L4/5小关节处有少量积液。她因不明原因发热和腰痛入院检查和治疗。自入院时采集的血培养首次报告革兰氏阳性球菌呈阳性后，住院次日开始抗生素治疗。由于腰痛和发热持续存在，住院第5天再次进行了MRI检查。重复MRI显示液体从左侧小关节延伸至椎旁肌肉和硬膜外间隙。她被诊断为PFJI，并进行了小关节穿刺。此时，很明显她在PFJI对侧的右侧出现了足下垂。她接受了冲洗、清创和部分椎板切除术。住院时的血培养、手术中采集的穿刺液和组织中均检测到甲氧西林敏感金黄色葡萄球菌（MSSA）。术后患者经过三个月的抗生素治疗后足下垂完全恢复。由于发病早期影像学表现可能不充分，且PFJI可能导致足下垂等神经功能缺损，即使住院后也需要仔细观察神经学表现，如果症状或临床体征没有改善或加重，应重新检查MRI。
