Abstract
BACKGROUND: Septic arthritis of the lumbar facet joint (SALFJ) is a rare condition that can lead to serious complications. The authors present an uncommon case in which SALFJ resulted in bacterial meningitis (BM) with hydrocephalus and pyogenic ventriculitis, causing a disturbance of consciousness. Reports describing perforation of the dura mater by an epidural abscess are rare, and the present case offers valuable insights into the management of complex and severe complications arising from SALFJ. OBSERVATIONS: A 54-year-old woman presented with impaired consciousness and paraplegia. The patient was eventually diagnosed with SALFJ at the left L3-4 facet joint complicated by BM, hydrocephalus, pyogenic ventriculitis, and acute transverse myelitis. Surgery confirmed a dural perforation, enabling direct invasion of the abscess into the central nervous system (CNS). Surgical interventions, including debridement, dural reconstruction, and local antibiotic perfusion, along with systemic antibiotics, significantly improved the patient's condition. LESSONS: This case highlights the potential for an epidural abscess of the SALFJ to directly perforate the dura mater, causing severe CNS complications. This emphasizes the importance of prompt diagnosis and appropriate surgical intervention in managing such complex cases. Timely lumbar surgery, combined with targeted antibiotic therapy, can be life-saving in this rare but critical scenario. https://thejns.org/doi/10.3171/CASE24621.