Lumbar Facet Joint Septic Arthritis Complicated by Spinal Epidural Abscess in Adolescents: Two Case Reports and a Literature Review

Septic arthritis of the spinal facet joint (SAFJ) is a rare spinal infection predominantly affecting adults and remains exceptional in pediatric and adolescent populations. Spinal epidural abscess (SEA) may occur as a complication and can lead to severe neurological deficits if diagnosis and treatment are delayed. We herein report two adolescent patients with lumbar SAFJ complicated by SEA. The first case involved a 14-year-old boy presenting with acute low back pain, fever, and rapid neurological deterioration culminating in cauda equina syndrome, requiring urgent surgical decompression and prolonged antibiotic therapy. The second case involved a 15-year-old girl presenting with acute low back pain and radiculopathy with a minor neurological deficit, successfully managed with conservative antibiotic treatment alone. Clinicians should maintain a high index of suspicion for SAFJ in children and adolescents presenting with acute localized back pain and fever. Early MRI evaluation is crucial to detect facet joint infection and epidural extension before the onset of neurological deterioration. Prompt individualized management, guided primarily by neurological status, can result in excellent functional outcomes.