Gas forming infection of the spine: a systematic and narrative review

Eran Beit Ner*, Yigal Chechik*, Laura Ann Lambert, Yoram Anekstein*, Yigal Mirovsky*, Yossi Smorgick*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review


Purpose: 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. Methods: 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. Results: 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. Discussion: 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. Level of evidence: Systematic review of level IV studies.

Original languageEnglish
Pages (from-to)1708-1720
Number of pages13
JournalEuropean Spine Journal
Issue number6
StatePublished - Jun 2021


  • Gas-forming
  • Infection
  • Necrotizing fasciitis
  • Osteomyelitis
  • Spine


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