Necrotizing Fasciitis Involving Spine: Unusual Medical Emergency for Spine Surgeon

Abstract

Background: Necrotizing fasciitis (NF) is a surgical diagnosis characterized by a rapidly progressive soft tissue infection, widespread tissue necrosis, and associated systemic illness. Friability of the superficial fascia, dishwater-gray exudate, and absence of pus are surgical characteristics of this diagnosis. Due to rapid progression of the infection, early recognition and aggressive surgical debridement are crucial to reduce mortality. Despite being commonly seen by general, plastic, and orthopedic surgeons, NF is an extremely rare spine surgery emergency. Our objective is to report on a case of NF involving the spine and highlight this unusual surgical emergency for the spine surgeon.

Case description: We present a rare case of a 61-year-old woman who presented to the emergency department in septic shock. She had a 1-week history of increasing back pain before presenting to us. Computed tomography revealed extensive soft tissue emphysema with involvement of the L3 vertebral body and spina canal. She underwent emergency surgical debridement. Despite maximal medical and surgical therapies, the patient died secondary to multisystem organ failure within 36 hours of initial presentation.

Conclusions: To the best of our knowledge, the literature presents only 1 previous case reported involving the spine. Necrotizing fasciitis is an unusual surgical spine surgery emergency. Spine surgeons should be aware of this diagnosis in order to provide timely aggressive surgical debridement.

Keywords: Klebsiella pneumoniae; Necrotizing fasciitis; Sepsis; Spinal column; Spine.