Postoperative synergistic gangrene after spinal fusion.

Abstract

A case of synergistic necrotizing gangrenous fasciitis after spinal surgery is reported. To describe this unusual complication, explain the rationale of treatment, and increase awareness of this serious postoperative complication. Although several cases of postoperative synergistic necrotizing fasciitis have been reported, there are no previously reported cases of this condition after spinal surgery. A rapidly progressive necrotizing spinal wound infection after fusion for degenerative disc disease was treated in a 39-year-old man. The infection was successfully treated with serial debridements, appropriate antibiotics, and hyperbaric wound oxygenation. The authors suggest adherence to the fundamental principles of treatment including radical surgical debridement and appropriate antibiosis for necrotizing gangrene after spinal surgery. In evaluation of aggressive spinal wound infections, diagnosis of synergistic necrotizing fasciitis should be kept in mind. Although hyperbaric wound oxygenation was implemented as an adjunct and appeared to aid in controlling the infection, its effect on outcome is not clear.