Resident UNC Neurosurgery Charlotte, North Carolina, United States
Introduction: Vertebral osteomyelitis is a bacterial infection of the vertebral body often caused by hematogenous spread from a distant site with 3-11% of cases effecting the cervical spine 1,2. Patients most as risk for osteomyelitis are intravenous drug users, patients with diabetes and males aged >50 years old. In severe cases where infection induces sagittal-plane deformity, surgical correction may be required. Surgical approaches include anterior-only, combined anteroposterior and posterior-only3. Few studies have reported on radiation exposure as a primary driver of the development of VO. Here we aim to To describe the complex surgical intervention that was undertaken for the treatment of radiation-induced cervical spinal kyphosis and compression deformity
Methods: We present the case of a 76-year-old female with a complex history of head and neck cancer. She presented with a one-year history of neck pain and progressive difficulty walking, using her hands, and having issues with gait and balance. Stage one of her operation included total laryngectomy, anterior C3-6 corpectomy, anterior column reconstruction, and a C2-7 anterior fusion. Stage two included a C2-T2 posterior instrumented fusion.
Results: Postoperatively, the patient no longer complained of any myelopathic symptoms. Scoliosis radiographs demonstrated a profound sagittal plane correction. CT and CTA of the cervical also showed intact instrumentation without any evidence of loosening. However, her post-operative course was complicated by wound dehiscence and persistent anterior neck fistula which required surgical intervention from otolaryngology. Both resolved within 1.5 months of surgery.
Conclusion : This is the first case illustration of its kind to be accompanied by a high quality visuals describing nuanced surgical techniques and further illustrates the powerful impact of interdisciplinary work with neurosurgical and otolaryngology teams.