Limits...
Vertebral osteomyelitis and epidural abscess caused by gas gangrene presenting with complete paraplegia: a case report.

Akagawa M, Kobayashi T, Miyakoshi N, Abe E, Abe T, Kikuchi K, Shimada Y - J Med Case Rep (2015)

Bottom Line: She was discharged 2 months later, at which time she was able to walk with a cane.Examination 18 months after surgery showed normal gait without a cane.Discitis caused by gas gangrene infection was successfully treated by immediate debridement and subsequent fusion surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Akita Kousei Medical Center, 1-1-1 Iijima-Nishifukuro, Akita, 011-0948, Japan. akagawamanabu@yahoo.co.jp.

ABSTRACT

Introduction: Gas gangrene is most often caused by Clostridium perfringens infection. Gas gangrene is a medical emergency that develops suddenly. The mortality rate is higher with trunk involvement than with involvement of the extremities, which carries a better prognosis. With respect to vertebral involvement, there are few reports in the literature. The purpose of this paper is to report a very rare case of vertebral osteomyelitis caused by gas gangrene.

Case presentation: A 78-year-old Japanese woman with diabetes mellitus was admitted to our hospital with the chief complaints of back pain, dysuria, and complete paralysis of both legs. A computed tomography scan showed soft tissue swelling anterolaterally at intervertebral disc level T11/12 and a gas-containing epidural abscess that compressed her spinal cord. Cultures later grew Clostridium perfringens and Escherichia coli. Hemilaminectomy was done from T10 to T12, and an epidural abscess was removed. She went on to have fusion surgery 6 weeks after the initial operation and subsequently experienced complete pain relief. She was discharged 2 months later, at which time she was able to walk with a cane. Examination 18 months after surgery showed normal gait without a cane.

Conclusions: Discitis caused by gas gangrene infection was successfully treated by immediate debridement and subsequent fusion surgery.

No MeSH data available.


Related in: MedlinePlus

Plain radiograph at 18 months after operation. Complete union between the T11 and T12 vertebral bodies is seen. Open arrow shows bone bridge between T11 and T12 vertebra. (a) Anteroposterior radiograph, (b) Lateral radiograph.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4403783&req=5

Fig4: Plain radiograph at 18 months after operation. Complete union between the T11 and T12 vertebral bodies is seen. Open arrow shows bone bridge between T11 and T12 vertebra. (a) Anteroposterior radiograph, (b) Lateral radiograph.

Mentions: Postoperatively, she experienced some sensory and motor return in her legs, but back pain and left chest pain in the sitting position continued. A CT scan 6 weeks after the operation showed T12 vertebral bone destruction (Figure 3); her WBC count and CRP were 8800 per mm3 and 0.26mg/dL, respectively. She went on to have fusion surgery with instrumentation and subsequently experienced complete relief of her pain. She was discharged 2 months later, at which time she was able to walk with a cane. Examination 18 months after surgery showed normal gait without a cane. Plain radiograph at 18 months after operation showed complete union between the T11 and T12 vertebral bodies (Figure 4).Figure 3


Vertebral osteomyelitis and epidural abscess caused by gas gangrene presenting with complete paraplegia: a case report.

Akagawa M, Kobayashi T, Miyakoshi N, Abe E, Abe T, Kikuchi K, Shimada Y - J Med Case Rep (2015)

Plain radiograph at 18 months after operation. Complete union between the T11 and T12 vertebral bodies is seen. Open arrow shows bone bridge between T11 and T12 vertebra. (a) Anteroposterior radiograph, (b) Lateral radiograph.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4403783&req=5

Fig4: Plain radiograph at 18 months after operation. Complete union between the T11 and T12 vertebral bodies is seen. Open arrow shows bone bridge between T11 and T12 vertebra. (a) Anteroposterior radiograph, (b) Lateral radiograph.
Mentions: Postoperatively, she experienced some sensory and motor return in her legs, but back pain and left chest pain in the sitting position continued. A CT scan 6 weeks after the operation showed T12 vertebral bone destruction (Figure 3); her WBC count and CRP were 8800 per mm3 and 0.26mg/dL, respectively. She went on to have fusion surgery with instrumentation and subsequently experienced complete relief of her pain. She was discharged 2 months later, at which time she was able to walk with a cane. Examination 18 months after surgery showed normal gait without a cane. Plain radiograph at 18 months after operation showed complete union between the T11 and T12 vertebral bodies (Figure 4).Figure 3

Bottom Line: She was discharged 2 months later, at which time she was able to walk with a cane.Examination 18 months after surgery showed normal gait without a cane.Discitis caused by gas gangrene infection was successfully treated by immediate debridement and subsequent fusion surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Akita Kousei Medical Center, 1-1-1 Iijima-Nishifukuro, Akita, 011-0948, Japan. akagawamanabu@yahoo.co.jp.

ABSTRACT

Introduction: Gas gangrene is most often caused by Clostridium perfringens infection. Gas gangrene is a medical emergency that develops suddenly. The mortality rate is higher with trunk involvement than with involvement of the extremities, which carries a better prognosis. With respect to vertebral involvement, there are few reports in the literature. The purpose of this paper is to report a very rare case of vertebral osteomyelitis caused by gas gangrene.

Case presentation: A 78-year-old Japanese woman with diabetes mellitus was admitted to our hospital with the chief complaints of back pain, dysuria, and complete paralysis of both legs. A computed tomography scan showed soft tissue swelling anterolaterally at intervertebral disc level T11/12 and a gas-containing epidural abscess that compressed her spinal cord. Cultures later grew Clostridium perfringens and Escherichia coli. Hemilaminectomy was done from T10 to T12, and an epidural abscess was removed. She went on to have fusion surgery 6 weeks after the initial operation and subsequently experienced complete pain relief. She was discharged 2 months later, at which time she was able to walk with a cane. Examination 18 months after surgery showed normal gait without a cane.

Conclusions: Discitis caused by gas gangrene infection was successfully treated by immediate debridement and subsequent fusion surgery.

No MeSH data available.


Related in: MedlinePlus