Purpose: To raise awareness of infectious spinal emphysema, a rare disease with very poor prognosis.
Methods: We present two cases of epidural emphysema involving the spinal column in two patients who came to the ED with back pain and preexisting uncontrolled diabetes.
Results: Both patients presented to the ED with back pain and elevated inflammatory markers. CT examination demonstrated gas in the epidural canal in both cases. One patient proceeded to undergo drainage and debridement of both spinal and abdominal abscesses with no marked improvement. Staph aureus blood cultures were confirmed in one patient, while the other had confirmed e. coli infection. Both patients deteriorated clinically in a matter of days and passed away due to multisystem organ failure.
Conclusions: Pneumorrhachis, or the presence of gas in the spinal column, is a rare condition which occurs as a result of various etiologies such as spontaneous pneumomediastium, trauma, and infection. We present two such cases with diagnosed spinal infection, one with relatively mild results on CT and one with a far more dramatic presentation, both of which resulted in rapid clinical deterioration and death.
