title: Subdural empyema following lumbar facet joint injection: An exceeding rare complication.
abstract: Chronic low back pain is extremely common with a life time prevalence estimated at greater than 70%. Facet joint arthrosis is thought to be the causative aetiological substrate in approximately 25% of chronic low back pain cases. Facet joint injection is a routine intervention in the armamentarium for both the diagnostic and therapeutic management of chronic low back pain. In fact, a study by Carrino et al. reported in excess of 94,000 facet joint injection procedures were carried out in the US in 1999. Although generally considered safe, the procedure is not entirely without risk. Complications including bleeding, infection, exacerbation of pain, dural puncture headache, and pneumothorax have been described. We report a rare case of a 47-year-old female patient who developed a left L4/5 facet septic arthrosis with an associated subdural empyema and meningitis following facet joint injection. This case is unique, as to the best of our knowledge no other case of subdural empyema following facet joint injection has been reported in the literature. Furthermore this case serves to highlight the potential serious adverse sequelae of a routine and apparently innocuous intervention. The need for medical practitioners to be alert to and respond rapidly to the infective complications of facet joint injection cannot be understated.
authors.affiliation: Department of Neurosurgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom. Electronic address: Fikayo19@hotmail.com.
authors.forename: Oluwafikayo
authors.initials: O
authors.lastname: Fayeye
authors.affiliation: Department of Neurosurgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom. Electronic address: Dulankasilva@googlemail.com.
authors.forename: Adikarige Haritha Dulanka
authors.initials: AH
authors.lastname: Silva
authors.affiliation: Department of Neuroradiology, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom. Electronic address: Swarupsinh.Chavda@uhb.nhs.uk.
authors.forename: Swarupsinh
authors.initials: S
authors.lastname: Chavda
authors.affiliation: Department of Neurosurgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom. Electronic address: Navin.Furtado@uhb.nhs.uk.
authors.forename: Navin Raoul
authors.initials: NR
authors.lastname: Furtado
mesh_terms: D013354:Empyema, Subdural / Q000209:etiology*; D005260:Female; D006801:Humans; D007267:Injections / Q000009:adverse effects*; D007270:Injections, Intra-Articular / Q000009:adverse effects; D007592:Joint Diseases / Q000209:etiology* / Q000382:microbiology; D017116:Low Back Pain / Q000188:drug therapy*; D008159:Lumbar Vertebrae; D008581:Meningitis / Q000209:etiology*; D008875:Middle Aged; D013256:Steroids / Q000008:administration & dosage; D021801:Zygapophyseal Joint
chemical_list: D013256:Steroids
keywords: Empyema; Facet joint; Infection; Injection; Subdural