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Case Reports
. 2018 Feb 18:2018:9076509.
doi: 10.1155/2018/9076509. eCollection 2018.

Pyogenic Spondylitis Caused by Methicillin-Resistant Staphylococcus aureus Associated with Tracheostomy followed by Resection of Ossification of the Anterior Longitudinal Ligament

Michio Hongo  1 , Naohisa Miyakoshi  1 , Masashi Fujii  1 , Yuji Kasukawa  1 , Yoshinori Ishikawa  1 , Daisuke Kudo  1 , Yoichi Shimada  1
Affiliations
Case Reports

Pyogenic Spondylitis Caused by Methicillin-Resistant Staphylococcus aureus Associated with Tracheostomy followed by Resection of Ossification of the Anterior Longitudinal Ligament

Michio Hongo et al. Case Rep Orthop. .

Abstract

Symptomatic ossification of the anterior longitudinal ligament (OALL) is rare. However, when the osteophyte enlarges and obstructive symptoms occur, the patient may require surgery. We present a case of pyogenic spondylitis caused by methicillin-resistant Staphylococcus aureus associated with tracheostomy followed by resection of OALL. A 69-year-old woman with OALL complained of dysphagia and suffocation, which was caused by prominent OALL at C4-5. Tracheostomy was performed, followed by osteophytectomy 6 weeks later. Two months after osteophytectomy, she complained of muscle weakness of the extremities, neck pain, and elevated temperature. Magnetic resonance imaging showed an intensity change at the C4-5 vertebrae and an epidural abscess that was causing cord compression requiring urgent decompression. Cultures identified methicillin-resistant Staphylococcus aureus. As osteolytic change and muscle weakness gradually progressed, she underwent anterior and posterior reconstruction with an autograft and instrumentation. Bone union was confirmed at 1 year postoperatively with improvement in neurological status. OALL has potentially the risk of airway obstruction. Therefore, appropriate diagnosis and prompt osteophytectomy are needed in cases of a large prominent ossification that puts the patient at risk of suffocation. However, it is noted that osteophytectomy following urgent tracheostomy carries the possible risk of infection.

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Figures

Figure 1
Figure 1
Esophagography showing prominent ossification of OALL compressing the esophagus and trachea.
Figure 2
Figure 2
Sagittal (a) and axial (b) image of CT showing extensive OALL at C4-5.
Figure 3
Figure 3
Sagittal CT image after removal of OALL.
Figure 4
Figure 4
Magnetic resonance imaging after removal of OALL showing spinal canal stenosis due to ossification of the posterior longitudinal ligament at C4-5.
Figure 5
Figure 5
Sagittal CT showing an osteolytic and destructive change at the C4 and 5 vertebra and local kyphosis.
Figure 6
Figure 6
Plain radiography 1 year postoperatively. (a) AP view and (b) lateral view.
See this image and copyright information in PMC

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