Huang Shiwei, Kappel Ari D, Peterson Catherine, Chamiraju Parthasarathi, Rajah Gary B, Moisi Marc D
Department of Neurosurgery, Detroit Medical Center/Wayne State University School of Medicine, Detroit, Michigan.
Seattle Science Foundation, Seattle, Washington, USA.
Surg Neurol Int. 2019 Aug 2;10:151. doi: 10.25259/SNI_240_2019. eCollection 2019.
Fungal cervical spondylodiscitis is rare and accounts for less than 1% of all cervical, thoracic, and lumbar vertebral osteomyelitis and discitis.
A 32-year-old non-immunocompromised male presented with persistent neck pain and paresthesias. The magnetic resonance imaging of the cervical spine demonstrated a contrast-enhancing erosive lesion involving the cervical C6 and C7 vertebral bodies accompanied by epidural phlegmon. Blood culture was negative. The patient underwent a C6 and C7 anterior corpectomy with instrumented fusion (e.g., expandable cage C5 to T1). Intraoperatively, frank pus was noted within the C6-C7 disc space and was accompanied by thick prevertebral and epidural phlegmon extending from C5 to T1. Intraoperative cultures grew . Three days later, a C6-C7 laminectomy with C4-T2 posterior instrumented fusion was performed; the cultures again grew . The patient was treated with intravenous micafungin for 14 days followed by 6-12 months of 400 mg oral fluconazole daily.
There are few cases in literature where non-immunocompromised patients developed fungal cervical spondylodiscitis. Prompt diagnosis and appropriate management are critical to effectively treat these patients. Surgical intervention may warrant corpectomy, discectomy, and operative debridement followed by long-term targeted antifungal therapy.
真菌性颈椎椎间盘炎较为罕见，在所有颈椎、胸椎和腰椎椎体骨髓炎及椎间盘炎中所占比例不到1%。
一名32岁非免疫功能低下男性，出现持续性颈部疼痛和感觉异常。颈椎磁共振成像显示一个增强造影的侵蚀性病变，累及颈椎C6和C7椎体，并伴有硬膜外蜂窝织炎。血培养结果为阴性。患者接受了C6和C7前路椎体次全切除术并植入器械融合（如，C5至T1的可扩张椎间融合器）。术中，在C6 - C7椎间盘间隙发现明显脓液，并伴有从C5延伸至T1的增厚的椎体前和硬膜外蜂窝织炎。术中培养长出……。三天后，进行了C6 - C7椎板切除术并进行C4 - T2后路器械融合；培养物再次长出……。患者接受了14天的静脉注射米卡芬净治疗，随后每日口服400毫克氟康唑，持续6 - 12个月。
文献中报道的非免疫功能低下患者发生真菌性颈椎椎间盘炎的病例较少。及时诊断和恰当处理对于有效治疗这些患者至关重要。手术干预可能需要椎体次全切除术、椎间盘切除术和手术清创，随后进行长期的针对性抗真菌治疗。
