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Iatrogenic (para-) spinal abscesses and meningitis following injection therapy for low back pain

Gaul, C.a,b,*; Neundörfer, B.a; Winterholler, M.a,b,c

doi: 10.1016/j.pain.2005.05.032

Low back pain is often treated with paraspinal injections of analgesics and steroids. Infectious complications of these techniques are rare but they can potentially hold high risks for the patients. History and clinical data of all patients admitted to a neurological unit suffering from community acquired purulent meningitis were prospectively analyzed during an 8 year interval (1992 and 2000) with special regard to the previous medical history. One hundred and twenty eight patients were included in the study. Eight out of 128 patients (6.25%) had a history of single or repeated paravertebral (4/8), facet-joint (2/8), peridural (1/8) or spinal (1/8) injections 2–21 days before admission to the hospital. In six out of eight patients either Staphylococcus aureus (4/8) or coagulase-negative staphylococci (2/8) were found in the cerebro spinal fluid (CSF), in two patients no causative organism was detected. One patient died, three survived with sequel. Repeated paraspinal, peridural or spinal injections with analgesic drugs in combination with corticosteroids hold a risk for parameningeal inoculation of bacteria resulting in paraspinal, spinal, and epidural abscesses or meningitis. The absolute frequency of these complications may be rare but they are responsible for a considerable proportion of community acquired purulent CNS infections.

aKlinik und Poliklinik für Neurologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany

bKlinik und Poliklinik für Neurologie, Martin-Luther-Universität, Germany

cNeurologische Klinik, Krankenhaus Rummelsberg, Germany

*Corresponding author. Klinik für Neurologie, Martin-Luther-Universität, Ernst-Grube-Straβe 40, 06097 Halle/Saale, Germany. Tel.: +49 345 5572858; fax: +49 345 5572020.


Received 12 October 2004; received in revised form 2 May 2005; accepted 23 May 2005.

© 2005 Lippincott Williams & Wilkins, Inc.
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