Vague neck pain following a gastrointestinal procedure: a rare case presentation of vertebral osteomyelitis and cervical epidural abscess

Abstract

Introduction: Vertebral osteomyelitis (VO), spondylodiscitis, and spinal epidural abscesses (SEA) are infectious and inflammatory processes impacting the spine that cause major morbidity and mortality. They require prolonged hospital stays with expensive treatment regimens. Along with acute management, studies have provided evidence highlighting poor long-term outcomes. VO accounts for ~2% of all osteomyelitis. Recent data have illustrated an increase in incidence to 5.4 per 100,000 person years. The majority of patients that present with SEA and VO typically have some combination of back pain, fevers, and neurological deficits.

Case presentation: A 55-year-old woman with known history of hypertension and hyperlipidemia, status-post endoscopic repair of a Zenker's Diverticulum 3 weeks prior, presented to our outpatient clinic with a 2-week history of axial cervical spine pain as well as left sided scapular and deltoid pain. Further questioning and exam revealed no neurologic deficits or fever. As pain persisted and she did not respond to treatment, further imaging was performed. She was found to have cervical discitis, osteomyelitis, and a cervical epidural abscess.

Discussion: Patients presenting with VO/SEA typically have spine pain with some other associated symptoms of spinal cord compression or fevers, making this a rare presentation. The urgency for discovery because of the need for emergent operative intervention is evident by the documented complications associated with a delay in diagnosis. This case report emphasizes the importance of always keeping VO/SEA on the differential for cervical spine pain even with lack of associated symptoms, in order to optimize patient care.

Fig. 1. MRI results in the sagittal plane.

Findings were read as: “C6–C7 discitis with associated osteomyelitis with significant anterior prevertebral soft tissue edema and marked phlegmon change extending from C5-T1 along the left anterior aspect of the vertebral bodies. It extends to the left lateral aspect of the vertebral bodies of C6–C7. A 9 mm abscess is seen anterior to the C7 vertebral body”.

Fig. 2. CT image results.

The patient’s CT image consistent with osteomyelitis, particularly “irregularity and erosion of the opposing endplates of C6 and C7 vertebral bodies”.