Can Lumbar Spinal Injections Cause Urinary Tract Infections?
Lumbar spinal injections do not directly cause urinary tract infections (UTIs), but patients with pre-existing urinary tract conditions—particularly recurrent UTIs or asymptomatic bacteriuria—are at increased risk of developing infectious complications, including septic arthritis, following these procedures.
Understanding the Relationship
The connection between lumbar spinal injections and UTIs is indirect rather than causal:
Pre-existing UTI as a Risk Factor
- Patients with recurrent UTIs or asymptomatic bacteriuria before spinal procedures are at higher risk for infectious complications after lumbar injections 1
- A case report documented septic facet joint arthritis following a periarticular facet injection specifically in a patient with recurrent urinary tract infections 1
- The infection risk stems from potential bacteremia or hematogenous spread from an existing urinary source to the injection site, not from the injection causing a UTI
Post-Surgical UTI Risk (Different Context)
In the context of spinal surgery (not simple injections), preoperative asymptomatic UTI significantly increases postoperative UTI risk (odds ratio 4.234), with an 8.1% preoperative aUTI rate and 4.1% postoperative UTI rate 2. However, this relates to surgical procedures with prolonged catheterization, not diagnostic or therapeutic spinal injections.
Clinical Implications and Prevention
Pre-Procedure Screening
Screen patients for active UTI symptoms and history of recurrent UTIs before performing lumbar spinal injections 1. While the ASA guideline emphasizes that "history, physical examination, and review of relevant laboratory studies is useful in identifying patients at increased risk of infectious complications" 3, it does not specifically mandate routine urine cultures for all patients.
Strict Aseptic Technique
The ASA guideline strongly recommends comprehensive aseptic techniques for all neuraxial procedures 3:
- Hand washing
- Sterile gloves
- Caps and masks covering mouth and nose
- Sterile draping of the patient
- Chlorhexidine with alcohol preferred for skin preparation
Post-Procedure Monitoring
Any worsening or recalcitrant back pain after facet injections should prompt investigation to rule out infectious causes, as the diagnosis of iatrogenic septic complications is often delayed because neurologic and constitutional symptoms develop slowly 1.
Important Caveats
- The evidence does not support that spinal injections cause UTIs in the bladder/urinary tract
- The concern is bidirectional: existing urinary infections can seed spinal structures after injection
- Do not confuse post-surgical UTIs (related to catheterization and surgical trauma) with complications from diagnostic/therapeutic spinal injections
- Post-procedure asymptomatic bacteriuria should not be routinely assessed or treated in the absence of symptoms