title: Vertebral osteomyelitis and epidural abscess caused by gas gangrene presenting with complete paraplegia: a case report.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Orthopedic Surgery, Akita Kousei Medical Center, 1-1-1 Iijima-Nishifukuro, Akita, 011-0948, Japan. akagawamanabu@yahoo.co.jp.
authors.forename: Manabu
authors.initials: M
authors.lastname: Akagawa
authors.affiliation: Department of Orthopedic Surgery, Akita Kousei Medical Center, 1-1-1 Iijima-Nishifukuro, Akita, 011-0948, Japan. takakoba825@hotmail.com.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kobayashi
authors.affiliation: Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan. miyakosh@doc.med.akita-u.ac.jp.
authors.forename: Naohisa
authors.initials: N
authors.lastname: Miyakoshi
authors.affiliation: Department of Orthopedic Surgery, Akita Kousei Medical Center, 1-1-1 Iijima-Nishifukuro, Akita, 011-0948, Japan. abe-e@akikumihsp.com.
authors.forename: Eiji
authors.initials: E
authors.lastname: Abe
authors.affiliation: Department of Orthopedic Surgery, Akita Kousei Medical Center, 1-1-1 Iijima-Nishifukuro, Akita, 011-0948, Japan. toshikiabe@jupiter.ocn.ne.jp.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Abe
authors.affiliation: Department of Orthopedic Surgery, Akita Kousei Medical Center, 1-1-1 Iijima-Nishifukuro, Akita, 011-0948, Japan. kazuma.kiku@gmail.com.
authors.forename: Kazuma
authors.initials: K
authors.lastname: Kikuchi
authors.affiliation: Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan. yshimada@hos.akita-u.ac.jp.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Shimada
mesh_terms: D001416:Back Pain / Q000382:microbiology; D003646:Debridement; D019299:Decompression, Surgical; D048909:Diabetes Complications; D015299:Discitis / Q000209:etiology; D020802:Epidural Abscess / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D005738:Gas Gangrene / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D007796:Laminectomy; D010019:Osteomyelitis / Q000209:etiology* / Q000601:surgery; D010264:Paraplegia / Q000209:etiology*; D011859:Radiography; D013123:Spinal Fusion