Department of Orthopedic Surgery, Yitzhak Shamir Medical Center, Zerifin, Israel.
Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Eur Spine J. 2021 Jun;30(6):1708-1720. doi: 10.1007/s00586-020-06646-7. Epub 2020 Oct 27.
Gas forming infection (GFI) of the spine is a rapidly progressive and potentially life-threatening infection. It can be a consequence of aetiologies such as Emphysematous Osteomyelitis (EOM), Necrotizing Fasciitis (NF), and Gas-containing Spinal Epidural Abscess (Gas-containing SEA). This review aims to summarize the characteristics of these subtypes of GFI, describing their aetiology, diagnosis, management, and prognosis.
PubMed, Embase, Web of Science and the Cochrane Database were systematically searched for studies reporting on gas forming infections of the spine or a known subtype. Cases of post-operative and iatrogenic spinal infection were excluded.
The literature review revealed 35 studies reporting on 28 cases of EOM, three cases of NF involving the spine and seven cases of Gas-containing SEA. Thirty studies reporting on 32 cases of GFI were available for data analysis. The mean age of the patients was 60.9 years and a concomitant diagnosis of diabetes mellitus was reported in 57.5% of patients infected. Fever and back pain were the most common presenting symptoms. The lumbar spine was the most commonly affected spinal segment. Mortality from EOM, NF and Gas-containing SEA were 34.8, 100 and 28.5%, respectively.
Gas forming infection of the spine is a rare condition with an extremely poor prognosis, requiring early and aggressive surgical treatment. A multi-disciplinary approach is necessary for management. Nonetheless, even in cases of early recognition and optimal management, multisystem failure may still occur, and mortality rates remain high due to the aggressive nature of this infection.
Systematic review of level IV studies.
脊柱气性感染（GFI）是一种迅速进展且潜在危及生命的感染。它可能是气肿性骨髓炎（EOM）、坏死性筋膜炎（NF）和含气性脊柱硬膜外脓肿（含气性 SEA）等病因的后果。本综述旨在总结这些 GFI 亚型的特征，描述其病因、诊断、治疗和预后。
系统检索了 PubMed、Embase、Web of Science 和 Cochrane 数据库中关于脊柱气性感染或已知亚型的研究。排除了术后和医源性脊柱感染的病例。
文献综述共报道了 28 例 EOM、3 例 NF 累及脊柱和 7 例含气性 SEA 的病例。有 30 项研究报告了 32 例 GFI 病例，可用于数据分析。患者的平均年龄为 60.9 岁，57.5%的感染患者同时患有糖尿病。发热和背痛是最常见的首发症状。腰椎是最常受累的脊柱节段。EOM、NF 和含气性 SEA 的死亡率分别为 34.8%、100%和 28.5%。
脊柱气性感染是一种罕见的疾病，预后极差，需要早期和积极的手术治疗。管理需要多学科方法。尽管如此，即使在早期识别和最佳管理的情况下，多系统衰竭仍可能发生，由于这种感染的侵袭性，死亡率仍然很高。
四级研究的系统评价。
