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: The patient was followed up at yearly interval 6th month followup. At his latest followup, (December 2008), his motor power was normal, and he was doing his routine activities satisfactorily. He was back to work. Anteroposterior and lateral flexion extension radiographs were done at followups to check for loosening of implant, signs of recurrence of infection, and adjacent level changes after the long fusion. Most recent imaging confirms adequate decompression of the spinal cord and good fusion from C2 to C7 [Figure 2]. X-rays did not show any instability at C1/C2 at the last followup.
No MeSH data available.