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Distant skip level discitis and vertebral osteomyelitis after caudal epidural injection: a case report of a rare complication of epidural injections

STUDY DESIGN: A case report of distant discitis and vertebral osteomyelitis involving skip levels after caudal epidural steroid injection. OBJECTIVES: To report and investigate the occurrence of distant infective discitis and vertebral osteomyelitis involving skip levels after epidural injection. SUMMARY OF THE BACKGROUND DATA: Distant discitis and vertebral osteomyelitis is a serious but rare complication after epidural injection. A case involving skip levels and without the occurrence of epidural abscess formation has apparently not been previously reported in the literature. METHODS: An elderly woman presenting with clinical, radiologic, and magnetic resonance imaging evidence of spinal canal stenosis involving L3/4 and L4/5 levels and degenerative spondylolisthesis of the L4/5 level was given an epidural injection of steroids and lignocaine via the caudal route. A month later, she presented with worsened low back pain, elevated serum acute phase reactants, and plain radiographic evidence of L4/5 infective discitis. Magnetic resonance imaging and microbiologic examination of computed tomographically guided biopsy specimens confirmed infective discitis involving L2/3 and L4/5 intervertebral levels, together with adjacent vertebral osteomyelitis. RESULTS: The patient was successfully treated with antibiotics targeted at Pseudomonas aeruginosa, which was isolated in the culture of the biopsy specimens. Follow-up improvements in the clinical condition, serum acute phase reactants levels, radiographs, and magnetic resonance imaging were noted. CONCLUSIONS: Distant discitis and vertebral osteomyelitis involving skip levels and without the occurrence of epidural abscess formation is a serious but rare complication after epidural injection

Keywords : Abscess,administration & dosage,adverse effects,Aged,Anesthesia,Caudal,Anesthetics,Anesthetics,Local,Back,Back Pain,Biopsy,complications,Culture,diagnosis,diagnostic imaging,Discitis,drug effects,drug therapy,Epidural Abscess,etiology,Female,Humans,Injections,Injections,Epidural,Intervertebral Disc,Lidocaine,Low Back Pain,Lumbar Vertebrae,Lumbosacral Region,Magnetic Resonance Imaging,methods,microbiology,Osteomyelitis,Pain,pathology,Pseudomonas aeruginosa,Pseudomonas Infections,Radiography,Singapore,Spinal Canal,Spinal Stenosis,Spondylolisthesis,Steroids,surgery,Triamcinolone,, Skip,Level,Discitis,Vertebral, mri in london

Date of Publication : 2003 Jun 1

Authors : Yue WM;Tan SB;

Organisation : Department of Orthopaedic Surgery, Singapore General Hospital, Singapore. yuewm@singnet.com.sg

Journal of Publication : Spine (Phila Pa 1976 )

Pubmed Link : https://www.ncbi.nlm.nih.gov/pubmed/12782996

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Distant skip level discitis and vertebral osteomyelitis after caudal epidural injection a case report of a rare complication of epidural injections | Fibromyalgia private treatment

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