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Necrotizing Infection of the Spine

Spock, Christopher R., BA; Miki, Roberto A., MD; Shah, Rahul V., MD; Grauer, Jonathan N., MD

doi: 10.1097/01.brs.0000217631.73632.37
Case Reports
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Study Design. Case report of multifocal necrotizing fasciitis with lumbar involvement.

Objectives. To raise awareness of an unusual, but potential, focus of a multifocal necrotizing infection in a diabetic patient.

Summary of Background Data. Necrotizing fasciitis is a rapidly spreading infection of the soft tissue and fascia. These infections can be polymicrobial, are challenging to treat, and often have grave consequences. The spine may rarely be involved in such infections.

Methods. We describe a patient with long-standing diabetic foot ulcers, which evolved to a necrotizing infection. This infection spread hematogenously to several noncontiguous locations, including the lumbar spine, and was heralded by gas production at the sites of involvement. The spine was treated aggressively and infection eradicated at this site.

Results. Despite eradicating the spinal component of this infection, other sites were challenging to clear, and the patient went on to die of multisystem organ failure.

Conclusions. Necrotizing infections rarely involve the spine. Heightened awareness of this potential focus of infection may facilitate its detection. As with other sites, aggressive surgical debridement of this potentially fatal condition is imperative.

A diabetic patient with who developed multifocal, polymicrobial necrotizing infections including the spine is presented. This was heralded by gas production at the sites of involvement. Once diagnosed, aggressive and repeated surgical debridements are advocated.

From the Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT.

Acknowledgment date: September 19, 2005. Acceptance date: October 19, 2005.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Jonathan Grauer, MD, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, PO Box 208071, New Haven, CT 06520-8071; E-mail: jonathan.grauer@yale.edu

© 2006 Lippincott Williams & Wilkins, Inc.