Discitis after lumbar epidural corticosteroid injection: a case report and analysis of the case report literature.
OBJECTIVE
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.


METHODS
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.


METHODS
Pain medicine clinic at a tertiary medical center.


METHODS
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.


RESULTS
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.


CONCLUSIONS
The identified clinical features and trends could prove useful to the practitioner when an infectious complication is suspected or has occurred.
Department of Anesthesiology and Psychiatry and Psychology, Mayo Clinic College of Medicine and Mayo Graduate School of Medicine, Rochester, Minnesota 55905, USA.
W Michael
WM
Hooten
Andrew
A
Mizerak
Paul E
PE
Carns
Marc A
MA
Huntoon
D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015299:Discitis / Q000139:chemically induced* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D007268:Injections, Epidural / Q000009:adverse effects*; D007275:Injections, Intravenous; D007403:Intervertebral Disc / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology; D017116:Low Back Pain / Q000188:drug therapy*; D008159:Lumbar Vertebrae / Q000187:drug effects* / Q000473:pathology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011843:Radiculopathy / Q000188:drug therapy / Q000503:physiopathology; D012585:Sciatica / Q000188:drug therapy / Q000503:physiopathology; D013203:Staphylococcal Infections / Q000139:chemically induced / Q000473:pathology / Q000503:physiopathology; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents