Gas forming infection of the spine: a systematic and narrative review

Ner, Eran Beit; Chechik, Yigal; Lambert, Laura-Ann; Anekstein, Yoram; Mirovsky, Yigal; Smorgick, Yossi

doi:10.1007/s00586-020-06646-7

Cited by 7 publications

(11 citation statements)

References 65 publications

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“…Clinical presentations for necrotizing fasciitis are non-specific and difficult to differentiate from other infectious diseases [ 1 – 3 ]. The presence of crepitation, swelling, or erythema is a clinical sign of necrotizing fasciitis [ 7 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…The prognosis of necrotizing fasciitis is extremely poor because of its rapidly destructive progression from local necrosis to systemic dissemination to sepsis [ 12 ]. Despite emergent surgical intervention, necrotizing fasciitis including from extra-axial to axial skeleton showed 34 % of mortality rate and associated with septic conditions [ 3 , 5 ]. For the cases of necrotizing fasciitis in axial skeleton, Beit Ner et al reviewed gas-forming infections of the spine and reported a 100 % mortality rate for necrotizing fasciitis [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…Despite emergent surgical intervention, necrotizing fasciitis including from extra-axial to axial skeleton showed 34 % of mortality rate and associated with septic conditions [ 3 , 5 ]. For the cases of necrotizing fasciitis in axial skeleton, Beit Ner et al reviewed gas-forming infections of the spine and reported a 100 % mortality rate for necrotizing fasciitis [ 3 ]. Similar to our case, the patient with necrotizing fasciitis suffered from the aggressive and rapidly progressing nature and died.…”

Section: Discussionmentioning

confidence: 99%

“…GFI involving the spine is especially rare, but it can be fatal due to conditions such as multi-organ failure [ 2 ]. Generally, GFI of the spine is a consequence of vertebral osteomyelitis, necrotizing fasciitis, or a gas-forming epidural abscess [ 3 ]. Since Bielecki et al first described GFI in 1986, its distinct clinical features and significance have been recognized [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…After 34 years from the initial description of GFI from Bielecki et al, the case of necrotizing fasciitis with gas-containing spinal epidural abscess across lumbar area to upper thoracic area has not been reported yet [ 3 ]. To the best our knowledge, this is the first case of fatal necrotizing fasciitis with rapid progression from the lumbar area to the upper thoracic area.…”

Section: Introductionmentioning

confidence: 99%

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Rapidly progressive gas-forming infection involving the spine as a life-threatening fatal condition : a case report

Kim

Ryu

Park

et al. 2021

BMC Musculoskelet Disord

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Background Gas forming infection of the spine is a consequence of vertebral osteomyelitis, necrotizing fasciitis, or a gas-forming epidural abscess, which is very rare and fatal conditions. This is the rare case of necrotizing fasciitis that rapidly progressed from the lumbar area to upper thoracic area. Case presentation A 58-year-old male complained of lower back pain with fever and chills. The patient had a history of uncontrolled diabetes mellitus without diabetic medication over the previous 3 months, and he had received several local injections around the lumbar area. Laboratory data revealed white blood cell count of 19,710 /mm3, erythrocyte sedimentation of 40 mm/h, and C-reactive protein of 30.7 mg/L. Radiological findings revealed a small amount of air bubbles in the paraspinal area and lumbar epidural spaces. The patient refused emergency surgery and was discharged from the hospital. The patient re-visited the emergency department two days after discharge complaining of more severe back pain with persistent fever, and his vital signs had deteriorated, with low blood pressure and tachycardia. K. pneumoniae was isolated in cultures from ultrasound-guided aspirates and peripheral blood. The follow-up radiographs revealed aggressive dissemination of innumerable air bubbles from the lumbar area to the T5 level. The patient underwent emergent decompressive laminectomy and debridement of infected paravertebral fascia and musculature. Despite intensive care for deteriorated vital signs and his back wound, the patient died on postoperative day 3 due to multi-organ failure. Conclusions Necrotizing fasciitis involving the spine is a very rare disease with life-threatening conditions, rapid progression, and a high mortality rate. Therefore, prompt surgical treatment with a high index of suspicion is imperative to prevent potentially fatal conditions in similar extremely rare cases.

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