Adjacent level spondylodiscitis after anterior cervical decompression and fusion.
Bottom Line: He showed neurological improvement after surgery but developed discharging sinus after 2 weeks, which healed with antibiotics.He improved on his preoperative symptoms well for the first 2 months.He was under regular followup for 5 years his myelopathy resolved completely and he is back to work.
Affiliation: Park Clinic, Gorky Terrace, Kolkata, India.
Postoperative spondylodiscitis after anterior cervical decompression and fusion (ACDF) is rare, but the same occurring at adjacent levels without disturbing the operated level is very rare. We report a case, with 5 year followup, who underwent ACDF from C5 to C7 for cervical spondylotic myelopathy. He showed neurological improvement after surgery but developed discharging sinus after 2 weeks, which healed with antibiotics. He improved on his preoperative symptoms well for the first 2 months. He started developing progressive neck pain and myelopathy after 3 months and investigations revealed spondylodiscitis at C3 and C4 with erosion, collapse, and kyphosis, without any evidence of implant failure or graft rejection at the operated level. He underwent reexploration and implant removal at the operated level (there was good fusion from C5 to C7) followed by debridement/decompression at C3, C4 along with iliac crest bone grafting and stabilization with plate and screws after maximum correction of kyphosis. The biopsy specimen grew Pseudomonas aeruginosa and appropriate sensitive antibiotics (gentamycin and ciprofloxacin) were given for 6 weeks. He was under regular followup for 5 years his myelopathy resolved completely and he is back to work. Complete decompression of the cord and fusion from C2 to C7 was demonstrable on postoperative imaging studies without any evidence of implant loosening or C1/C2 instability at the last followup.
No MeSH data available.
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Mentions: 39-year-old gentleman who noticed progressive difficulty in walking along with tingling sensation in all four limbs since September 2002. He was diagnosed to be suffering from spastic quadriparesis due to cervical spondylotic myelopathy secondary to prolapsed intervertebral disc at C5/6 and C6/7 levels and was operated in July 2003 in another hospital. Through a left anterior approach, C6 corpectomy, C5/6 and 6/7 discectomy and autogenous bone grafting was done along with stabilization using stainless steel plate/screws [Figure 1a, b]. He made good postoperative recovery with improvement in gait, paresthesia, and grip strength. Radiograph done in the immediate postoperative period was showing a stable graft implant construct in proper alignment. In the postoperative period, around 2 weeks, he noticed a discharging sinus from the operation site, which healed completely with antibiotics at around 4 weeks (records of culture/sensitivity of that hospital were not available, but as the sinus had healed well, we presumed the organism had responded to the antibiotic prescribed). As there was clear evidence of postoperative infection at the surgical site, further investigation with a sinogram and computed tomography (CT) scan at this point with proper recording of the investigations could have yielded much better insight about the progression of the disease. This remains a limitation of this study.
No MeSH data available.