Abstract
Hematogenous septic arthritis of the lumbar facet is a well-recognized although rare1-5 primary infectious entity of the spine. Traditionally, the most commonly implicated organism has been Staphylococcus aureus1,2,6 . Although there have been reports of methicillin-resistant Staphylococcus aureus (MRSA) spondylodiscitis7, methicillin-resistant Staphylococcus aureus as a cause of hematogenous facet joint septic arthritis has not been described, to our knowledge. We report our experience with the treatment of two cases of facet joint septic arthritis due to methicillin-resistant Staphylococcus aureus . The patients were informed that data concerning these cases would be submitted for publication, and they consented. Case 1. A fifty-three-year-old man presented with an eighteen-day history of severe back pain radiating to the left lower limb. He was unable to walk because of the intensity of pain. He had retention of urine, for which he required catheterization. Apart from being a chronic smoker, he had no medical comorbidities. Clinical examination revealed severe tenderness over the left side of the lower back. Neurological examination of the left lower extremity revealed grade-2 (of 5) strength of the extensor hallucis longus and tibialis anterior muscles. Lower extremity sensation and deep tendon reflexes were normal. Rectal examination revealed a lax anal sphincter and an absent bulbocavernosus reflex. Hematological examination showed an erythrocyte sedimentation rate of 77 mm/hr (normal, 6 to 12 mm/hr), a total white blood-cell count of 17.4 × 109/L (normal, 4.3 to 10.8 × 109/L), and a C-reactive protein level of 60 mg/L (normal, <6 mg/L). Plain radiographs were unremarkable. Magnetic resonance imaging demonstrated altered signal intensity in the left L4-L5 facet joint, with fluid causing widening of the joint and extending into the adjacent left paraspinal and psoas muscles (Fig. 1-A). The paraspinal muscle fluid …
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