Cervical Discitis and Epidural Abscess After Tonsillectomy (original) (raw)
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Acute cervical osteomyelitis and prevertebral abscess after routine tonsillectomy
The Spine Journal, 2008
BACKGROUND CONTEXT: Tonsillectomy is among the most commonly performed surgical procedures. The development of severe infection after tonsillectomy is a very rare but potentially fatal complication that has not been described in the orthopedic, neurosurgical, or spine literature. PURPOSE: To present acute cervical osteomyelitis and prevertebral abscess formation as a complication of a routine tonsillectomy. STUDY DESIGN: Case report, literature review. METHODS: A case report was prepared on the clinical and radiographic data of a patient presenting with prevertebral abscess and acute cervical osteomyelitis 6 weeks after routine tonsillectomy. A review of relevant literature was additionally performed. RESULTS: The patient presented 6 weeks after tonsillectomy with evidence of a deep cervical infection. Operative debridement with anterior and posterior surgical stabilization was performed. The patient completed a 6-week course of intravenous antibiotics. At 24-month follow-up, the patient showed no signs of infection and demonstrated a stable fusion mass. CONCLUSIONS: The development of prevertebral abscess and acute cervical osteomyelitis has been discussed in a small number of otolaryngology case reports and has not been previously reported in the orthopedic, neurosurgical, or spine literature. Symptoms may be nonspecific, and so a high index of clinical suspicion is needed. Delay in treatment may lead to significant morbidity and even mortality. Successful treatment can be obtained through operative debridement and intravenous antibiotic therapy. Ó
Cervical osteomyelitis following tonsillectomy
Anaesthesia, 1997
We present a case of fatal cervical osteomyelitis following an elective tonsillectomy in a previously fit young man. Following induction of general anaesthesia, and prior to surgery, the patient received bilateral glossopharyngeal nerve blocks with 0.5% bupivacaine and adrenaline 1:200 000. The initial recovery was uneventful but persistent throat and neck pain developed at home which was diagnosed as a throat infection and possible hyperextension injury of the neck. It is impossible to say how much the dissection of chronically infected tonsils or the infiltration of local anaesthetic into or near a potentially infected area contributed to the development of cervical osteomyelitis. The absence of any other symptoms and signs, a normal blood count and cervical spine X-ray, and the rarity of cervical osteomyelitis, all contributed to a delay in diagnosis.
Unusual Fatal Infections after Anterior Cervical Spine Surgeries
Korean Journal of Spine, 2012
We report two cases of cervical spinal epidural abscess (SEA), which are related to anterior cervical surgeries. The first case reveals a late postoperative infection without any predisposing factor. The second case reveals combined complication of infection and instrument failure (artificial disc). Both two cases manifested ascending infections that are unusual courses of anterior cervical infections. The abscess extended upwards and, finally, caused life threatening bacterial meningitis. We suggest aggressive surgical interventions with anti-bacterial therapies in such cases.
Idiopathic cervical osteomyelitis presenting as dysphagia
2010
We discuss a case of idiopathic cervical epidural abscess, complicated by osteomyelitis, presenting with dysphagia as the main complaint. No predisposing factors were identified and blood cultures were negative. Case was treated conservatively by long course of IV antibiotics. We present a review of presentation of spinal epidural abscesses and indications for surgical intervention.
Parapharyngeal Abscess Two Years After Elective Tonsillectomy
Journal of Medical Cases, 2014
Parapharyngeal abscesses are the second most common site of deep neck infections, and should not be underestimated due to potentially fatal complications. A case of parapharyngeal abscess in a young patient, with a previous history of elective tonsillectomy performed 2 years before, is reported.
Upper Cervical Spine Infection. Complication of Hypopharyngeal Injury
International Journal of Otolaryngology and Head & Neck Surgery, 2016
Background: We describe a rare case of Candida albicans retropharyngeal infection with upper cervical spondylodiscitis associated with epidural abscess triggered by ingestion of a chicken bone. Case Description: A 63-year-old woman presented with posterior neck and bilateral shoulders pain three weeks after choking on a 2-centimeter chicken bone. Magnetic resonance imaging (MRI) revealed spondylodiscitis and epidural abscess with significant spinal cord compression at C2 and C3 levels. A Barium swallow showed a focal disruption of the posterior wall of the esophagus. A posterior upper cervical fixation (C2-C5) was initially performed. One week later an anterior decompressive procedure was carried out followed by iliac crest bony fusion, and repair of the esophageal defect. Intra-operative cultures showed heavy growth of Candida albicans. After a transitory post-operative neurologic worsening, and after six weeks of appropriate antifungal therapy, the patient achieved a full clinical and radiologic recovery. Conclusion: Prompt surgical debridement, fusion and stabilization combined with adequate antimicrobial agents are necessary to guarantee a good outcome and reverse the neurological deficits.
Anterior Cervical Infection: Presentation and Incidence of an Uncommon Postoperative Complication
Global spine journal, 2017
Retrospective multi-institutional case series. The anterior cervical discectomy and fusion (ACDF) affords the surgeon the flexibility to treat a variety of cervical pathologies, with the majority being for degenerative and traumatic indications. Limited data in the literature describe the presentation and true incidence of postoperative surgical site infections. A retrospective multicenter case series study was conducted involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network, selected for their excellence in spine care and clinical research infrastructure and experience. Medical records for 17 625 patients who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, inclusive, were reviewed to identify the occurrence of 21 predefined treatment complications. Patients who underwent an ACDF were identified in the database and reviewed for the occurrence of postoperative anterior cervical infectio...
2013
Vertebral osteomyelitis is a rare but serious complication of spinal-epidural analgesia and anesthesia. We report two cases of two level vertebral osteomyelitis and psoas abscess without spinal epidural abscess after spinal and epidural anesthesia. The first patient with psoas abscess was successfully treated with CT guided needle drainage and posterior spinal decompression with L1-L2 instrumented fusion and antibiotics. Second patient was successfully treated with antibiotics and posterior decompression with T12-L1 and L4-L5 posterior instrumented fusion
Factors related to post surgical neurologic improvement for cervical spine infection
Biomedical Journal, 2018
Background: Cervical spine infections are uncommon but potentially dangerous, having the highest rate of neurological compromise and resulting disability. However, the factors related to surgical success is multiple yet unclear. Methods: We retrospectively reviewed the medical records of 27 patients (16 men and 11 women) with cervical spine infection who underwent surgical treatment at Chang Gung Memorial Hospital, Linkou branch, between 2001 and 2014. The neurological status, by Frankel classification, was recorded preoperatively and at discharge. Group X had neurologic improvement of at least 1 grade, group Y had unchanged neurologic status, and group Z showed deterioration. We recorded the patient demographic data, presenting symptoms and signs, interval from admission to surgery, surgical procedure, laboratory data, perioperative antibiotic course, pathogens identified, coexisting medical disease, concomitant nonspinal infection, and clinical outcomes. We intended to evaluate the different characteristics of patients who improved neurologically after treatment. Results: The mean age of our cohort was 56.6 years. Anterior cervical discectomy and fusion was the most commonly performed surgical procedure (74.1%). The Frankel neurological status improved in 70.4% (group X, n ¼ 19) and unchanged in 29.6% (group Y, n ¼ 8). No patients worsened. Motor weakness was most common (96.3%) neurological deficit, followed by sensory abnormalities (37.0%), and bowel/urine incontinence (33.3%). The main difference in presentation between group X and group Y was neck pain (100% vs. 75.0%; p ¼ .02), not fever. Group X had a shorter preoperative antibiotic course (p ¼ .004), interval from admission to operation (p ¼ .02), and hospital stay (p ¼ .01). Conclusion: Clinicians should be more suspicious in patients who present with neck pain and any neurological involvement even in those without fever while establishing early diagnosis. Earlier operative treatment in group X result in better neurologic recovery and shorter hospital stay due to disease improvement.