Department of Spine Surgery, Beijing Shijitan Hospital, Capital Medical University, No.10 Tieyi Road, Yangfangdian, Beijing, 100038, China.
BMC Musculoskelet Disord. 2019 Sep 25;20(1):437. doi: 10.1186/s12891-019-2783-x.
Anterior cervical discectomy and fusion (ACDF) is often performed for the treatment of degenerative cervical spine. While this procedure is highly successful, 0.1-1.6% of early and late postoperative infection have been reported although the rate of late infection is very low.
Here, we report a case of 59-year-old male patient who developed deep cervical abscess 30 days after anterior cervical discectomy and titanium cage bone graft fusion (autologous bone) at C3/4 and C4/5. The patient did not have esophageal perforation. The abscess was managed through radical neck dissection approach with repated washing and removal of the titanium implant. Staphylococcus aureus was positively cultured from the abscess drainage, for which appropriate antibiotics including cefoxitin, vancomycin, levofloxacin, and cefoperazone were administered postoperatively. In addition, an external Hallo frame was used to support unstable cervical spine. The patient's deep cervical infection was healed 3 months after debridement and antibiotic administration. His cervial spine was stablized 11 months after the surgery with support of external Hallo Frame.
This case suggested that deep cervical infection should be considered if a patient had history of ACDF even in the absence of esophageal perforation.
颈椎前路椎间盘切除融合术（ACDF）常用于治疗退行性颈椎病。虽然该手术成功率很高，但仍有 0.1%-1.6%的患者报告发生术后 1 天至 1 年内的早期和晚期感染，尽管晚期感染的发生率非常低。
在此，我们报告了 1 例 59 岁男性患者，在 C3/4 和 C4/5 行颈椎前路椎间盘切除、钛笼植骨融合（自体骨）后 30 天出现深部颈椎脓肿。患者没有食管穿孔。脓肿通过根治性颈清扫术处理，反复冲洗和取出钛植入物。从脓肿引流物中培养出金黄色葡萄球菌，术后给予头孢西丁、万古霉素、左氧氟沙星和头孢哌酮等适当抗生素治疗。此外，还使用外部 Halo 框架来支撑不稳定的颈椎。清创和抗生素治疗 3 个月后，患者的深部颈椎感染得到治愈。术后 11 个月，在外部 Halo 框架的支撑下，患者的颈椎得到稳定。
如果患者有 ACDF 病史，即使没有食管穿孔，也应考虑深部颈椎感染的可能性。
