ABSTRACT

Background Data:

Recently, the development of algology and the increase of algological initiatives have accompanied complications. Especially in patients with immune system disorders, epidural abscesses, facet joint septic arthritis, or abscess formation in paravertebral muscles have significantly increased after corticosteroid injections, especially applied to the disc, around nerve roots and facet joints.

Aim:

The aim of this study is to evaluate the cases of infections after 1028 algological treatments in 3 hospitals.

Patients and Method:

In this study, 24 patients who were referred to Orthopedics and Traumatology clinics with low back pain and fever, were evaluated retrospectively. 16 of the patients were male and 8 were females. The mean age was determined as 62.6 ± 10.4 (46-92). These patients were questioned for diabetes mellitus, history of tuberculosis, immunodeficiency syndromes and their epidemiological characteristics. The isolated microorganisms and complications associated with clinical findings have been evaluated and classified. In addition, it has been investigated whether the infections are eradicated or not in these treatments. Root blockage was found in 12 (50%) of the infected patients, facet joint injection in 6 (25%) and paravertebral intramuscular injection in 6 (25%). 4 (16.7%) of these patients developed epidural abscesses, 4 (16.7%) had facet joint septic arthritis, and 16 (66.6%) of them developed paravertebral intramuscular abscess formation. All of the patients were surgically drained and facet joint fusion was performed in the cases of septic arthritis.

Results:

There were 1028 cases of algological intervention in the last two years in these three hospitals. It was determined that 24 or more of these cases developed superficial or deep infection. The infection rate was generally found to be as high as 2.34%. Additionally, It was found that 8 (33.3%) of the patients had received insulindependent diabetes mellitus treatment, 12 (50%) received oral antidiabetic drugs due to Type-2 diabetes, and 1 patient had a treated tuberculosis. No cases were found to have immunodeficiency (such as AIDS). Prophylactic antibiotics were not used in any of the patients. At the end of the treatment regimen, CRP and ESR values decreased statistically and came to normal values (p <0.05). The variance analysis shows that the most important predisposing factors were; cigarette, DM and the processing conditions of the injections (p <0.05).

Conclusion:

It has been detected that the use of prophylactic antibiotics is particularly important in patients with impaired immune system and diabetes mellitus. It has been suggested that the most important measure in the prevention of infections in algological interventions is to perform these procedures in sterile conditions, especially in operating room conditions with positive pressured ventilation.