Late prevertebral abscess with sinus following anterior cervical corpectomy and fusion

Abstract

Anterior cervical discectomy/corpectomy and fusion is performed in degenerative, traumatic and neoplastic etiologies of the cervical spine. This procedure is highly successful and associated with fewer complications. The rates of early and late postoperative infection have been reported to be between 0.1% and 1.6%, the late infections are being very rare. We report a rare case of a 30-year-old HIV negative, non-diabetic male who developed a late prevertebral cervical abscess with discharging sinus over posterior triangle of neck 3 years after an anterior cervical C6 corpectomy with fibular grafting and buttress screw fixation performed elsewhere for traumatic fracture C6 vertebra. The abscess was drained using radical neck dissection approach with complete excision of sinus track and removal of the infected implant. On culture, the organism was found to be beta-hemolytic streptococci, for which appropriate antibiotics were administered postoperatively. The sinus tract completely healed in 3 months time. Late infection as a complication of anterior cervical spine surgeries is rare and is associated with esophageal perforation, implant migration, seeding of the deep prevertebral space with oropharyngeal flora, or from surgical site/bacteremia or with Zenker's diverticulum. Few cases have been reported till date, but none have presented with a sinus tract. We present a case of delayed prevertebral abscess after cervical spine instrumentation that followed abnormal path causing sinus track to be developed in the site (the posterior triangle of the neck) other than previous incision site. Exploring both triangles of the neck using radical neck dissection approach was essential for complete excision of sinus track, removal of screw and debridement.

Late deep cervical infection after anterior cervical discectomy and fusion: a case report and literature review

“…In cases of deep cervical abscess regardless of esophageal perforation, the infecting organisms are usually those belonging to the normal bacterial flora of the pharyngo-esophageal tract, which include several types of staphylococci, streptococci, neisseriae, clostridium, and the infection is often of mixed bacteria [34]. In our patient, the causative organism was Staphylococcus aureus , which was positively cultured from the abscess drainage.…”

Late Retropharyngeal and Parapharyngeal Abscess in Patients with a History of Anterior Cervical Discectomy and Fusion

“…[19][20][21] There is a lack of data in the literature regarding delayed presentation of infection in patients who undergo ACDF with most being single case reports (Table 2). 13,14,[22][23][24][25][26][27] Given the relatively small number of cases we identified on chart review, it is unlikely that late infection is a direct cause of having a previous ACDF. Primary spondylitis or discitis, unrelated to the patient's prior ACDF, is a possible source for retropharyngeal abscesses in some of the cases reported here, particularly in those with no evidence of esophageal perforation.…”