Cervical Facet Joint Infection and Associated Epidural Abscess with Streptococcus intermedius from a Dental Infection Origin A Case Report and Review.
Pyogenic cervical facet joint infections are rare and such infections from a dental origin are even less common. Of these few cases, none have described infection with Streptococcus intermedius as the pathogen. A 65-year-old orthopaedic surgeon complained of fevers, right-sided radiating neck pain, stiffness, swelling, erythema, and right upper extremity weakness one month after he had broken a crown over his right mandibular premolar, a continued source of pain. Imaging of the cervical spine showed a right C4-C5 facet inflammatory arthropathy and a small epidural abscess that was cultured and initially treated with intravenous antibiotics. The oral maxillofacial surgery team performed an extraction of the infected, symptomatic tooth. For continued right upper extremity weakness, the patient underwent C4-C5 laminoforaminotomy and irrigation and debridement of the right C4-C5 facet joint. After 6 weeks of intravenous antibiotics, the patient's infectious and inflammatory markers had normalized. By 4 months, he had regained full strength at his upper extremity and a painless and full range of motion of his cervical spine.Pyogenic cervical facet joint infection is very rare and potentially dangerous. A high clinical suspicion and appropriate imaging, including magnetic resonance imaging, are important for correct diagnosis. Prompt medical and surgical treatment may avert complications, and although the patient presented made a complete recovery, patients may be left with neurological compromise.
Ian David
ID
Kaye
Themistocles S
TS
Protopsaltis
D061605:Administration, Intravenous; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000503:physiopathology / Q000601:surgery; D003442:Crowns; D019232:Dental Restoration Failure; D020802:Epidural Abscess / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000503:physiopathology / Q000601:surgery; D059526:Foraminotomy; D006801:Humans; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D008297:Male; D020127:Recovery of Function; D013290:Streptococcal Infections / Q000175:diagnosis / Q000382:microbiology* / Q000503:physiopathology / Q000601:surgery; D034367:Streptococcus intermedius / Q000302:isolation & purification*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014076:Tooth Diseases / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000601:surgery; D014081:Tooth Extraction; D016896:Treatment Outcome; D021801:Zygapophyseal Joint / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000503:physiopathology / Q000601:surgery
D000900:Anti-Bacterial Agents