Late deep cervical infection after anterior cervical discectomy and fusion: a case report and literature review

Ying-Chun Chen,Yu Hou,Wei Yuan,Li-Xiang Ding,Lin Zhang,Gen-Ai Zhang,Er-Nan Li

doi:10.1186/s12891-019-2783-x

Ying-Chun Chen, Yu Hou + Show 5 more

Open Access

https://doi.org/10.1186/s12891-019-2783-x

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Abstract

BackgroundAnterior cervical discectomy and fusion (ACDF) is often performed for the treatment of degenerative cervical spine. While this procedure is highly successful, 0.1–1.6% of early and late postoperative infection have been reported although the rate of late infection is very low.Case presentationHere, we report a case of 59-year-old male patient who developed deep cervical abscess 30 days after anterior cervical discectomy and titanium cage bone graft fusion (autologous bone) at C3/4 and C4/5. The patient did not have esophageal perforation. The abscess was managed through radical neck dissection approach with repated washing and removal of the titanium implant. Staphylococcus aureus was positively cultured from the abscess drainage, for which appropriate antibiotics including cefoxitin, vancomycin, levofloxacin, and cefoperazone were administered postoperatively. In addition, an external Hallo frame was used to support unstable cervical spine. The patient’s deep cervical infection was healed 3 months after debridement and antibiotic administration. His cervial spine was stablized 11 months after the surgery with support of external Hallo Frame.ConclusionsThis case suggested that deep cervical infection should be considered if a patient had history of ACDF even in the absence of esophageal perforation.

Highlights

Anterior cervical discectomy and fusion (ACDF) is often performed for the treatment of degenerative cervical spine
This case suggested that deep cervical infection should be considered if a patient had history of ACDF even in the absence of esophageal perforation
Anterior cervical discectomy and fusion (ACDF) procedure has been widely performed for degenerative disc disease, traumatic cervical diseases, or cervical spondylosis [1,2,3,4]

Summary

Introduction

Anterior cervical discectomy and fusion (ACDF) is often performed for the treatment of degenerative cervical spine. Conclusions: This case suggested that deep cervical infection should be considered if a patient had history of ACDF even in the absence of esophageal perforation. Late infection after an interval of time after ACDF may present with various symptoms and signs including neck pain, dysphagia, and fever accompanied with laboratory abnormalities such as elevated white blood cell count, ESR, and CRP [7, 17].

Results

Conclusion