Anterior cervical discectomy and fusion (ACDF) is a common spinal procedure with a low complication rate. Although dysphagia and recurrent laryngeal nerve paralysis are well-documented, deep surgical site infections (SSIs) are rare (0.03%–0.3%). This report presents a rare case of deep SSI with an epidural abscess post-ACDF and analyzes the incidence of SSI in Sweden using Swespine data.
Case Presentation:
A 55-year-old female developed cervicothoracic pain and bilateral arm pain three weeks after C6/7 ACDF. Imaging confirmed deep SSI with an epidural abscess. Despite antibiotic agents, reoperation was required 37 days post-operatively, involving C7 corpectomy and titanium reconstruction. Cultures identified oral flora, suggesting hematogenous spread from untreated dental caries. Swespine data showed a 0.05% incidence of deep SSI among 9,382 cases.
Conclusions:
Deep SSI following ACDF is an exceptionally rare but serious complication. Cervicothoracic pain may indicate SSI, and pre-operative dental care is advisable to reduce infection risk.
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References
1.
FountasKN, KapsalakiEZ, NikolakakosLG, et al.Anterior cervical discectomy and fusion associated complications. Spine (Phila Pa 1976), 2007; 32(21):2310–2317; doi: 10.1097/BRS.0b013e318154c57e
StieberJR, BrownK, DonaldGD, et al.Anterior cervical decompression and fusion with plate fixation as an outpatient procedure. Spine J, 2005; 5(5):503–507; doi: 10.1016/j.spinee.2005.01.011
4.
ShriverMF, LewisDJ, KshettryVR, et al.Dysphagia rates after anterior cervical diskectomy and fusion: A systematic review and meta-analysis. Global Spine J, 2017; 7(1):95–103; doi: 10.1055/s-0036-1583944
5.
OhLJ, DibasM, GhozyS, et al.Recurrent laryngeal nerve injury following single- and multiple-level anterior cervical discectomy and fusion: A meta-analysis. J Spine Surg, 2020; 6(3):541–548; doi: 10.21037/jss-20-508
6.
TasiouA, GiannisT, BrotisAG, et al.Anterior cervical spine surgery-associated complications in a retrospective case-control study. J Spine Surg, 2017; 3(3):444–459; doi: 10.21037/jss.2017.08.03
7.
RaiV, SharmaV, KumarM, et al.A systematic review of risk factors and adverse outcomes associated with anterior cervical discectomy and fusion surgery over the past decade. J Craniovertebr Junction Spine, 2024; 15(2):141–152; doi: 10.4103/jcvjs.jcvjs_168_23
8.
DanielsAH, KawaguchiS, ContagAG, et al.Hospital charges associated with “never events”: comparison of anterior cervical discectomy and fusion, posterior lumbar interbody fusion, and lumbar laminectomy to total joint arthroplasty. J Neurosurg Spine, 2016; 25(2):165–169; doi: 10.3171/2015.11.Spine15776
9.
GhobrialGM, HarropJS, SassoRC, et al.Anterior Cervical Infection: Presentation and Incidence of an Uncommon Postoperative Complication. Global Spine J, 2017; 7(1 Suppl):12s–16s; doi: 10.1177/2192568216687546
10.
BertalanffyH, EggertHR. Complications of anterior cervical discectomy without fusion in 450 consecutive patients. Acta Neurochir (Wien), 1989; 99(1–2):41–50; doi: 10.1007/bf01407775
11.
JinSW, KimSH, ChoiJI, et al.Late infection from anterior cervical discectomy and fusion after twenty years. Korean J Spine, 2014; 11(1):22–24; doi: 10.14245/kjs.2014.11.1.22
12.
BasuS, SreeramalingamR. Adjacent level spondylodiscitis after anterior cervical decompression and fusion. Indian J Orthop, 2012; 46(3):360–363; doi: 10.4103/0019-5413.96367
13.
KulkarniAG, HeeHT. Adjacent level discitis after anterior cervical discectomy and fusion (ACDF): A case report. Eur Spine J, 2006; 15(Suppl 5):559–563; doi: 10.1007/s00586-005-0003-x
14.
McCarthyS, MilneD, O’ConnorK, et al.Cervical epidural abscess: A blind spot for postmortem computed tomography. Am J Forensic Med Pathol, 2022; 43(3):273–276; doi: 10.1097/paf.0000000000000742
15.
PengXQ, SunCG, FeiZG, et al.Risk factors for surgical site infection after spinal surgery: A systematic review and meta-analysis based on twenty-seven studies. World Neurosurg, 2019; 123:e318–e329; doi: 10.1016/j.wneu.2018.11.158
16.
WattersW3rd, RethmanMP, HansonNB, et al.; American Dental Association. Prevention of orthopaedic implant infection in patients undergoing dental procedures. J Am Acad Orthop Surg, 2013; 21(3):180–189; doi: 10.5435/jaaos-21-03-180
17.
BarrereS, ReinaN, PetersOA, et al.Dental assessment prior to orthopedic surgery: A systematic review. Orthop Traumatol Surg Res, 2019, 105(4):761–772; doi: 10.1016/j.otsr.2019.02.024 31060914
18.
SobottkeR, CsécseiG, KaulhausenT, et al.[Spinal surgery in the elderly: Does age have an influence on the complication rate?]. Orthopade, 2008, 37(4):367–373; doi: 10.1007/s00132-008-1233-5
19.
PeeYH, ParkJD, ChoiY-G, et al.Anterior debridement and fusion followed by posterior pedicle screw fixation in pyogenic spondylodiscitis: autologous iliac bone strut versus cage. J Neurosurg Spine, 2008; 8(5):405–412; doi: 10.3171/spi/2008/8/5/405
20.
KorovessisP, VardakastanisK, FennemaP, et al.Mesh cage for treatment of hematogenous spondylitis and spondylodiskitis. How safe and successful is its use in acute and chronic complicated cases? A systematic review of literature over a decade. Eur J Orthop Surg Traumatol, 2016; 26(7):753–761; doi: 10.1007/s00590-016-1803-x
21.
RobinsonY, TschoekeSK, KayserR, et al.Reconstruction of large defects in vertebral osteomyelitis with expandable titanium cages. Int Orthop, 2009; 33(3):745–749; doi: 10.1007/s00264-008-0567-2
