• W Michael Hooten, Andrew Mizerak, Paul E Carns, and Marc A Huntoon.
• Department of Anesthesiology and Psychiatry and Psychology, Mayo Clinic College of Medicine and Mayo Graduate School of Medicine, Rochester, Minnesota 55905, USA.
• Pain Med. 2006 Jan 1;7(1):46-51.

ObjectiveThe primary objective is to document the first case report of discitis after a lumbar epidural corticosteroid injection. The second objective is to analyze the case report literature to identify clinical features and trends of patients with infectious complications after spinal injections.DesignSingle case report. A MEDLINE and EMBASE literature search was conducted using key words from the names of commonly performed spinal procedures, including epidural corticosteroid, selective nerve root, transforaminal epidural, facet joint, and sacroiliac joint injections.SettingPain medicine clinic at a tertiary medical center.PatientA 64-year-old man with an 8-year history of left lower extremity radicular pain and recurrent pulmonary infections was referred for a lumbar epidural corticosteroid injection. Six weeks following the injection, the patient returned with a 4-week history of worsening right-sided paraspinous pain without associated recurrent pneumonia. Magnetic resonance imaging revealed a right-sided L5-S1 disc extrusion with discitis and a right L5-S1 discectomy was performed. Cultures of disc material and blood showed growth of coagulase-negative Staphylococcus, and a transesophageal echocardiogram showed no evidence of endocarditis. The patient received 6 weeks of intravenous antibiotics and he had symptomatic recovery at 3-month follow-up.ResultsIncluding our patient, the literature search identified 27 case reports of infectious complications. Similar clinical features and significant trends were evident in five categories including predisposing factors, symptom presentation, diagnostic evaluation, etiological organisms, and treatment outcomes.ConclusionsThe identified clinical features and trends could prove useful to the practitioner when an infectious complication is suspected or has occurred.

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