Cervical spondylodiscitis associated with oesophageal perforation: a rare complication after anterior cervical fusion

Abstract

Anterior cervical instrumented fusion is a commonly performed spinal surgery with relatively low complication rate. Especially, spinal infections are very rare and often associated with oesophageal perforation secondary to hardware migration. We present a rare complication of cervical spondylodiscitis in a 24-year-old man after an anterior cervical fusion. He had sustained a C5/C6 fracture dislocation associated with incomplete tetraplegia and he was treated by a combined staged posterior (lateral mass screws) and anterior (plate, PEEK) cervical fusion with an uneventful postoperative course with exception of light dysphagia for liquids. Three months after surgery, the patient developed fever and severe dysphagia. A barium-swallow study was indicative for oesophageal perforation, while MRI of the neck demonstrated spondylodiscitis C5/C6 accompanied by a prevertebral and epidural abscess. The treatment consisted of surgical debridement and evacuation of the abscesses, removal of the anterior spinal implants and insertion of a mesh cage with iliac bone graft. The weakened oesophagus posterior wall was enhanced with resorbable interrupted sutures and a 6-week course of antibiotics was administered. Dysphagia improved significantly while interbody fusion occurred 5 months following revision surgery. Five years postoperatively motor and sensor function had returned to normal limits. Dysphagia or deterioration of preexisted dysphagia in the late postoperative setting should be considered carefully and evaluated for oesophageal perforation and complicated spinal infection. In the case of not completed fusion, removal of the implants followed by meticulous debridement and insertion of titanium mesh cage, filled with autogenous bone graft lead to successful fusion and infection eradication.