Myonecrosis of paralumbar spine muscle

A case report.

To report a case of myonecrosis in the paralumbar spinal muscle.

Diabetic myonecrosis is an uncommon and often a missed complication of poor controlled diabetes. It usually occurs in the lower extremities with thigh pain and swelling. Occurrence in the paraspinal muscle is rare with no previous reports of this condition.

A 45-year-old obese man came to the emergency department with one week history of sudden onset severe left sided low back pain. On physical examination, the left side of the lumbar area is swollen and tender to touch and quite tense with palpation. The right side is soft and non-tender. The patient is neurologically intact lower extremities. Magnetic resonance imaging (MRI) shows destruction and swelling of the muscles left paralumbar area from the thoracolumbar junction down to the sacrum.

The patients pain had improved significantly with analgesics and bed rest. MRI images that were obtained 10 weeks later show remarkable diminish of abnormal signal in the posterior paraspinal muscles on the left side and a few tiny pockets of fluid were identified. Although there does remain some bright signal involving the muscle bundle, there has been much improvement in this regard.

Diabetic myonecrosis is a reminder that aggressive diabetic control is essential in all patients to avoid end-organ damage. Diabetic myonecrosis may occur in paralumbar spinal muscle as well as thigh. When diabetic have severe back pain and tenderness with high signal intensity on T2 weighted MRI image, myonecrosis should be included in the differential diagnosis although one consider abscess or cellulitis primarily. The episode of myonecrosis in diabetic is marker of poor control and poor prognosis. Main strategy of treatment is pain control and immobilization, supportive care and diabetes control.