Open AccessVertebral Osteomyelitis: A Potentially Catastrophic Outcome after Lumbar Epidural Steroid Injection
Author(s) -
Thomas Simopoulos
Publication year - 2008
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2008/11/693
Subject(s) - medicine , epidural abscess , epidural steroid injection , vertebral osteomyelitis , surgery , epidural space , osteomyelitis , complication , lumbar , radicular pain , abscess , interventional pain management , back pain , spinal stenosis , discitis , magnetic resonance imaging , anesthesia , low back pain , radiology , pain management , pathology , alternative medicine
Background and Objective: Epidural steroid injections are commonly used topalliate the symptoms of spinal stenosis. Deep tissue infection is a known potential complication of these injections. There have been no previous published cases of osteomyelitis without epidural abscess after such injections. We present acase in an elderly patient who presented only with persistent axial low back painfollowing a lumbar epidural steroid injection (LESI). We emphasize early patientevaluation, consideration of infectious predisposing factors, sterile technique, andskin disinfectant.Design: Open-label case report.Case description: A 77-year-old diabetic male with a history of radicular painrelated to lumbar spinal stenosis was treated successfully several years prior with aseries of lumbar epidural steroid injections (LESI) and was re-treated with LESIs forrecurrent symptoms. Following his second epidural injection, he presented withback pain and induration at the injection site without fever or neurological deficits.Urgent magnetic resonance imaging (MRI) revealed a soft tissue abscess extending close to the epidural space around the corresponding L4/L5 vertebral level. Thepatient recovered after incision and drainage of the abscess which was associatedwith an osteomyelitis of the L4 and L5 vertebral spine. The causative organism wasmethicillin-resistant Staphylococcus Aureus.Conclusion: This case demonstrates that even with proper aseptic techniques,immune-compromised patients who are colonized with an aggressive micro-organism may develop a potentially catastrophic infectious complication if subtlepersistent symptomatic complaints are not promptly and carefully evaluated.Key words: osteomyelitis, epidural steroid injection, methicillin-resistant staphylococcus aureus (MRSA)