Abstract
BackgroundVertebral osteomyelitis is a rare, life-threatening condition. Successful management is dependent on prompt diagnosis and management with intravenous antibiotic therapy or surgery in addition to antibiotics. Reoccurrence is minimal after 1 year. However, very little is reported in the conservative spine literature regarding the long-term follow-up and the changes to the spine following management of the spinal infection. We report the dramatic radiologic findings of the long-term sequela of a cervical spine infection following a gunshot wound from 1969. Most impressive to the spine specialist is this patient’s ability to return to work despite significant alterations to spinal biomechanics.Case presentationA 69 year-old caucasian male presented to the chiropractic clinic at a Veterans Affairs Medical Center with complaint of chronic left shoulder pain secondary to an associated full thickness tear of the left infraspinatus. An associated regional assessment of the cervical spine ensued. Radiological imaging on file revealed ankylosis C2/C3 to C7/T1. The patient reported a history of multiple fragment wounds in 1969 to the left anterior neck and shoulder 45 years earlier. Osteomyelitis of the cervical spine resulted from the wounds.ConclusionPotential sequela of osteomyelitis is ankylosis of affected joints. In this particular case, imaging provides evidence of regional ankylosis of the cervical spine. Considering the patient did not complain of cervical pain or related symptoms apart from lack of cervical range of motion, and his Neck Disability Index score was 2 out of 50 (4%), no intervention was provided to the cervical spine. The patient reported he self-managed well, worked full-time as a postal worker after he was discharged due to the injury to his neck, and planned to retire in less than one month at age 70. The patient demonstrates successful return to work with pending retirement at age 70 following spondylodiscitis and subsequent ankylosis of the cervical region.
Highlights
Vertebral osteomyelitis is a rare, life-threatening condition
Considering the patient did not complain of cervical pain or related symptoms apart from lack of cervical range of motion, and his Neck Disability Index score was 2 out of 50 (4%), no intervention was provided to the cervical spine
We present the imaging findings of an individual who suffered from vertebral osteomyelitis (VO) 45 years earlier and continued to work full-time
Summary
Spontaneous interbody ankylosis of the effected segments following spondylodiscitis is an expected progression of the condition. The spine practitioner should be aware of this response to spondylodiscitis when the patient is managed non-surgically. The spine practitioner can positively influence patients to return to work with an encouraging prognosis despite such a diagnosis. This case is exceptionally unique because, unexpectedly, the facet joints of the effected segments are observed to be ankylosed as well without observed spinal cord involvement. ETS and CDW performed a specific review of non-surgical ankylosis following spondylodiscitis and provided radiological interpretation expertise for preparation of the manuscript. All authors read and approved the final manuscript. The consent form is held by the authors in the patients’ clinical notes and is available for review by the Editor-in-Chief. Author details 1Physical Medicine & Rehabilitative Services, VA Butler Healthcare, 353 North Duffy Road, Butler, PA 16001, USA. 2Department of Chiropractic Clinical Sciences, New York Chiropractic College, Seneca Falls, USA
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