Department of Neurosurgery, College of Medicine, Yeungnam University, Daegu, Korea.
Spine (Phila Pa 1976). 2011 Aug 1;36(17):E1162-5. doi: 10.1097/BRS.0b013e31820407d2.
A case report.
To report a case of myonecrosis in the paralumbar spinal muscle.
Diabetic myonecrosis is an uncommon and often a missed complication of poor controlled diabetes. It usually occurs in the lower extremities with thigh pain and swelling. Occurrence in the paraspinal muscle is rare with no previous reports of this condition.
A 45-year-old obese man came to the emergency department with one week history of sudden onset severe left sided low back pain. On physical examination, the left side of the lumbar area is swollen and tender to touch and quite tense with palpation. The right side is soft and non-tender. The patient is neurologically intact lower extremities. Magnetic resonance imaging (MRI) shows destruction and swelling of the muscles left paralumbar area from the thoracolumbar junction down to the sacrum.
The patients pain had improved significantly with analgesics and bed rest. MRI images that were obtained 10 weeks later show remarkable diminish of abnormal signal in the posterior paraspinal muscles on the left side and a few tiny pockets of fluid were identified. Although there does remain some bright signal involving the muscle bundle, there has been much improvement in this regard.
Diabetic myonecrosis is a reminder that aggressive diabetic control is essential in all patients to avoid end-organ damage. Diabetic myonecrosis may occur in paralumbar spinal muscle as well as thigh. When diabetic have severe back pain and tenderness with high signal intensity on T2 weighted MRI image, myonecrosis should be included in the differential diagnosis although one consider abscess or cellulitis primarily. The episode of myonecrosis in diabetic is marker of poor control and poor prognosis. Main strategy of treatment is pain control and immobilization, supportive care and diabetes control.
病例报告。
报告一例腰旁脊柱肌肌坏死病例。
糖尿病性肌坏死是一种罕见且常被忽视的糖尿病控制不佳的并发症。它通常发生在下肢，表现为大腿疼痛和肿胀。发生在脊柱旁肌肉的情况很少见，以前没有这种情况的报告。
一名 45 岁肥胖男性因突发严重左侧腰痛一周来到急诊部。体格检查时，左侧腰部肿胀，触诊时压痛明显，且触感紧张。右侧腰部柔软，无压痛。下肢神经完整。磁共振成像（MRI）显示从胸腰椎交界处到骶骨的左侧腰旁区域的肌肉破坏和肿胀。
患者的疼痛在使用镇痛药和卧床休息后明显改善。10 周后获得的 MRI 图像显示左侧后脊柱旁肌肉的异常信号明显减少，并且仅发现几个小的液袋。尽管肌肉束中仍存在一些明亮的信号，但在这方面已经有了很大的改善。
糖尿病性肌坏死提醒我们，所有患者都必须积极控制糖尿病，以避免靶器官损伤。糖尿病性肌坏死可发生在腰旁脊柱肌和大腿。当糖尿病患者出现严重腰痛和压痛，T2 加权 MRI 图像上出现高信号强度时，尽管首先考虑脓肿或蜂窝织炎，但应将肌坏死纳入鉴别诊断。糖尿病性肌坏死是控制不佳和预后不良的标志。治疗的主要策略是止痛和固定、支持性护理和糖尿病控制。
