Presentation
Low back pain.
Patient Data
Arthritic changes of the right L5-S1 facet joint showing intra-articular effusion, articular surfaces erosive changes, and bone marrow edema, associated with paraspinal extension showing small abscess and surrounding soft tissue edema of the right erector spinae muscle. No evidence of spondylodiscitis or epidural abscess.
L3 1st-degree degenerative spondylolisthesis.
Lumbar spondylosis.
L2-3 posterior and left posterolateral disc protrusion is encroaching upon the left neural exit foramen.
L3-4 diffuse posterior disc bulge inclined to the left side is encroaching upon the neural exit foramen.
Right L5-S1 facet joint arthropathy evident by the narrowing of its joint space and erosive changes of their articular surfaces. This is associated with paraspinal extra-articular extension.
Case Discussion
Septic arthritis is a rare serious entity, which can be secondary to disc or vertebral infection (spondylodiscitis). An isolated form should raise suspicion of the septic cause, especially in diabetic or immunocompromised patients via a hematogenous spread of extra-spinal infections, tuberculosis, or iatrogenic cause (facet joint injection or acupuncture).
Facet joint septic arthritis may show paraspinal or epidural extension. In our case, it showed paraspinal muscular extension with the formation of a small abscess. MRI is the proper diagnostic tool in the assessment of facet joint septic arthritis and the associated complications.
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