title: Spinal epidural abscess with pyogenic arthritis of facet joint treated with antibiotic-bone cement beads - a case report -.
abstract: Most epidural abscesses are a secondary lesion of pyogenic spondylodiscitis. An epidural abscess associated with pyogenic arthritis of the facet joint is quite rare. To the best of our knowledge, there is no report of the use of antibiotic-cement beads in the surgical treatment of an epidural abscess. This paper reports a 63-year-old male who sustained a 1-week history of radiating pain to both lower extremities combined with lower back pain. MRI revealed space-occupying lesions, which were located in both sides of the anterior epidural space of L4, and CT scans showed irregular widening and bony erosion of the facet joints of L4-5. A staphylococcal infection was identified after a posterior decompression and an open drainage. Antibiotic- bone cement beads were used as a local controller of the infection and as a spacer or an indicator for the second operation. An intravenous injection of anti-staphylococcal antibiotics resolved the back pain and radicular pain and normalized the laboratory findings. We point out not only the association of an epidural abscess with facet joint infection, but also the possible indication of antibiotic-bone cement beads in the treatment of epidural abscesses.
authors.affiliation: Department of Orthopedic Surgery, Halla General Hospital, Jeju, Korea.
authors.forename: Bong-Jin
authors.initials: BJ
authors.lastname: Lee
authors.forename: Sung-Rak
authors.initials: SR
authors.lastname: Lee
authors.forename: Seong-Tae
authors.initials: ST
authors.lastname: Kim
authors.forename: Tae-Ho
authors.initials: TH
authors.lastname: Kim
authors.forename: Sang-Hoon
authors.initials: SH
authors.lastname: Lee
references.citation: J Rheumatol. 1992 Nov;19(11):1817-9
references.pmid: 1491410
references.citation: Neuroradiology. 1995 Aug;37(6):462-4
references.pmid: 7477859
references.citation: Skeletal Radiol. 1990;19(6):453-5
references.pmid: 2218597
references.citation: J Bone Joint Surg Br. 1987 May;69(3):457-9
references.pmid: 3584201
references.citation: Spine (Phila Pa 1976). 1995 Jun 1;20(11):1304-6
references.pmid: 7660242
references.citation: Spine (Phila Pa 1976). 1992 Dec;17(12):1514-6
references.pmid: 1471012
references.citation: Clin Orthop Relat Res. 1984 Nov;(190):96-108
references.pmid: 6386264
references.citation: Spine (Phila Pa 1976). 1988 Aug;13(8):948-52
references.pmid: 3055342
references.citation: Spine (Phila Pa 1976). 2001 Jul 15;26(14):1570-6
references.pmid: 11462088
references.citation: Clin Orthop Relat Res. 1997 Jun;(339):109-12
references.pmid: 9186208