This case highlights the importance of early recognition of post-procedural complications, particularly infections following spinal interventions. Pain physicians should maintain a low threshold for urgent imaging to exclude epidural hematoma or infection and initiate early antibiotic therapy when red flags arise. Patient education regarding potential risks and early warning signs is crucial for timely intervention and prevention of long-term morbidity.
Facet joint pain is a common source of chronic low back pain, arising from the synovial joints of the lumbar spine. It accounts for approximately 15–45% of chronic low back pain cases [1, 2], with prevalence increasing with age, degenerative changes and mechanical stress [3]. Diagnosis can be challenging due to symptom overlap with other lumbar conditions. Management includes patient education, lifestyle changes, education, simple analgesics and physiotherapy. NICE guidance advises that diagnostic MBBs can be performed to assess if RFA may be beneficial [4, 5]. In this case, management was complicated by the patient’s ICD which is a relative contraindication to RFA [6] and using shared decision making, lumbar facet joint injections were performed.
Although generally safe, facet joint injections carry a small risk of infection with potentially serious consequences [7, 8]. The usage of proper antiseptic technique is mandatory to avoid such complications [9]. Risk factors include immunocompromised states and multiple injections [10]. Septic arthritis may present subtly without fever, making high clinical suspicion crucial. MRI remains the diagnostic gold standard, and management typically involves prolonged antibiotic therapy, with or without surgical drainage depending on neurological status.
