Back
 IJOHNS  Vol.5 No.2 , March 2016
Upper Cervical Spine Infection. Complication of Hypopharyngeal Injury
Abstract: Background: We describe a rare case of Candida albicans retropharyngeal infection with upper cervical spondylodiscitis associated with epidural abscess triggered by ingestion of a chicken bone. Case Description: A 63-year-old woman presented with posterior neck and bilateral shoulders pain three weeks after choking on a 2-centimeter chicken bone. Magnetic resonance imaging (MRI) revealed spondylodiscitis and epidural abscess with significant spinal cord compression at C2 and C3 levels. A Barium swallow showed a focal disruption of the posterior wall of the esophagus. A posterior upper cervical fixation (C2-C5) was initially performed. One week later an anterior decompressive procedure was carried out followed by iliac crest bony fusion, and repair of the esophageal defect. Intra-operative cultures showed heavy growth of Candida albicans. After a transitory post-operative neurologic worsening, and after six weeks of appropriate antifungal therapy, the patient achieved a full clinical and radiologic recovery. Conclusion: Prompt surgical debridement, fusion and stabilization combined with adequate antimicrobial agents are necessary to guarantee a good outcome and reverse the neurological deficits.
Cite this paper: Skaf, G. and Elias, E. (2016) Upper Cervical Spine Infection. Complication of Hypopharyngeal Injury. International Journal of Otolaryngology and Head & Neck Surgery, 5, 96-102. doi: 10.4236/ijohns.2016.52016.
References

[1]   Dahiya, M. and Denton, J.S. (1999) Esophagoaortic Perforation by Foreign Body (Coin) Causing Sudden Death in a 3-Year-Old Child. American Journal of Forensic Medicine & Pathology, 20, 184-188.
http://dx.doi.org/10.1097/00000433-199906000-00016

[2]   Fonga-Djimi, H., Leclerc, F., Martinot, A., Hue, V., Fourier, C., Deschildre, A. and Flurin, V. (1996) Spondylodiscitis and Mediastinitis after Esophageal Perforation Owing to a Swallowed Radiolucent Foreign Body. Journal of Pediatric Surgery, 31, 698-700.
http://dx.doi.org/10.1016/S0022-3468(96)90677-6

[3]   Ngan, J.H., Fok, P.J., Lai, E.C., Branicki, F.J. and Wong, J. (1990) A Prospective Study on Fish Bone Ingestion. Experience of 358 Patients. Annals of Surgery, 211, 459-462.
http://dx.doi.org/10.1097/00000658-199004000-00012

[4]   Sakamoto, M., Ichimura, K., Tayama, N., Nakamura, M. and Inokuchi, K. (1999) Cervical Vertebral Osteomyelitis Revisited: A Case of Retropharyngeal Abscess and Progressive Muscle Weakness. Otolaryngology—Head and Neck Surgery, 121, 657-660.
http://dx.doi.org/10.1016/S0194-5998(99)70078-1

[5]   Ruiz, A., Post, J.D. and Ganz, W.I. (1995) Inflammatory and Infectious Processes of the Cervical Spine. Neuroimaging Clinics of North America, 5, 401-425.

[6]   McCullers, J.A. and Flynn, P.M. (1998) Candida Tropicalis Osteomyelitis: Case Report and Review. Clinical Infectious Diseases, 26, 1000-1001.
http://dx.doi.org/10.1086/517629

[7]   Gouliouris, T., Aliyu, S.H. and Brown, N.M. (2010) Spondylodiscitis: Update on Diagnosis and Management. Journal of Antimicrobial Chemotherapy, 65, iii11-iii24.
http://dx.doi.org/10.1093/jac/dkq303

[8]   Belzunegui, J., Del Val, N., Intxausti, J.J., De Dios, J.R., Queiro, R., González, C., Rodríguez-Valverde, V. and Figueroa, M. (1999) Vertebral Osteomyelitis in Northern Spain. Report of 62 Cases. Clinical and Experimental Rheumatology, 17, 447-452.

[9]   Beronius, M., Bergman, B. and Andersson, R. (2001) Vertebral Osteomyelitis in Goteborg, Sweden: A Retrospective Study of Patients during 1990-95. Scandinavian Journal of Infectious Diseases, 33, 527-532.

[10]   Euba, G., Narváez, J.A., Nolla, J.M., Murillo, O., Narváez, J., Gómez-Vaquero, C. and Ariza, J. (2008) Long-Term Clinical and Radiological Magnetic Resonance Imaging Outcome of Abscess-Associated Spontaneous Pyogenic Vertebral Osteomyelitis under Conservative Management. Seminars in Arthritis and Rheumatism, 38, 28-40.
http://dx.doi.org/10.1016/j.semarthrit.2007.08.007

[11]   Hadjipavlou, A.G., Mader, J.T., Necessary, J.T. and Muffoletto, A.J. (2000) Hematogenous Pyogenic Spinal Infections and Their Surgical Management. Spine (Phila Pa 1976), 25, 1668-1679.
http://dx.doi.org/10.1097/00007632-200007010-00010

[12]   Derkinderen, P., Bruneel, F., Bouchaud, O. and Regnier, B. (2000) Spondylodiscitis and Epidural Abscess Due to Candida albicans. European Spine Journal, 9, 72-74.
http://dx.doi.org/10.1007/s005860050013

[13]   Skaf, G.S., Sabbagh, A.S. and Hadi, U. (2007) The Advantages of Submandibular Gland Resection in Anterior Retropharyngeal Approach to the Upper Cervical Spine. European Spine Journal, 16, 469-477.
http://dx.doi.org/10.1007/s00586-006-0228-3

[14]   Malawski, S.K. and Lukawski, S. (1991) Pyogenic Infection of the Spine. Clinical Orthopaedics and Related Research, No. 272, 58-66.
http://dx.doi.org/10.1097/00003086-199111000-00009

[15]   Korovessis, P., Sidiropoulos, P., Piperos, G. and Karagiannis, A. (1993) Spinal Epidural Abscess Complicated Closed Vertebral Fracture. A Case Report and Review of Literature. Spine (Phila Pa 1976), 18, 671-674.
http://dx.doi.org/10.1097/00007632-199304000-00020

[16]   Ghanayem, A.J. and Zdeblick, T.A. (1996) Cervical Spine Infections. Orthopedic Clinics of North America, 27, 53-67.

[17]   Yang, E.C. and Neuwirth, M.G. (1988) Pseudomonas Aeruginosa as a Causative Agent of Cervical Osteomyelitis. Case Report and Review of the Literature. Clinical Orthopaedics and Related Research, No. 231, 229-233.
http://dx.doi.org/10.1097/00003086-198806000-00031

[18]   Battista, R.A., Baredes, S., Krieger, A. and Fieldman, R. (1993) Prevertebral Space Infections Associated with Cervical Osteomyelitis. Otolaryngology—Head and Neck Surgery, 108, 160-166.
http://dx.doi.org/10.1177/019459989310800209

[19]   Reid, P.J. and Holman, P.J. (2007) Iatrogenic Pyogenic Osteomyelitis of C-1 and C-2 Treated with Transoral Decompression and Delayed Posterior Occipitocervical Arthrodesis. Case Report. Journal of Neurosurgery: Spine, 7, 664-668.
http://dx.doi.org/10.3171/SPI-07/12/664

[20]   Schimmer, R.C., Jeanneret, R.C., Nunley, P. and Jeanneret, B. (2002) Osteomyelitis of the Cervical Spine: A Potentially Dramatic Disease. Journal of Spinal Disorders & Techniques, 15, 110-117.
http://dx.doi.org/10.1097/00024720-200204000-00004

[21]   Khazim, R.M., Debnath, U.K. and Fares, Y. (2006)Candida Albicans Osteomyelitis of the Spine: Progressive Clinical and Radiological Features and Surgical Management in Three Cases. European Spine Journal, 15, 1404-1410.
http://dx.doi.org/10.1007/s00586-005-0038-z

[22]   Lewis, R.E. and Klepser, M.E. (1999) The Changing Face of Nosocomial Candidemia: Epidemiology, Resistance, and Drug Therapy. American Journal of Health-System Pharmacy, 56, 525-533.

[23]   Hendrickx, L., Van Wijngaerden, E., Samson, I. and Peetermans, W.E. (2001) Candidal Vertebral Osteomyelitis: Report of 6 Patients, and a Review. Clinical Infectious Diseases, 32, 527-533.
http://dx.doi.org/10.1086/318714

[24]   Hsieh, P.C., Wienecke, R.J., O’Shaughnessy, B.A., Koski, T.R. and Ondra, S.L. (2004) Surgical Strategies for Vertebral Osteomyelitis and Epidural Abscess. Neurosurgical Focus, 17, E4.
http://dx.doi.org/10.3171/foc.2004.17.6.4

[25]   Chen, W.H., Jiang, L.S. and Dai, L.Y. (2007) Surgical Treatment of Pyogenic Vertebral Osteomyelitis with Spinal Instrumentation. European Spine Journal, 16, 1307-1316.
http://dx.doi.org/10.1007/s00586-006-0251-4

[26]   Darouiche, R.O. (2006) Spinal Epidural Abscess. The New England Journal of Medicine, 355, 2012-2020.
http://dx.doi.org/10.1056/NEJMra055111

[27]   Bydon, M., De la Garza-Ramos, R., Macki, M., Naumann, M., Sciubba, D.M., Wolinsky, J.P., Bydon, A., Gokaslan, Z.L. and Witham, T.F. (2014) Spinal Instrumentation in Patients with Primary Spinal Infections Does Not Lead to Higher Recurrent Infection Rates: An Analysis of 118 Cases. World Neurosurgery, 82, 807-814.
http://dx.doi.org/10.1016/j.wneu.2014.06.014

[28]   Guven, O. (1996) Posterior Instrumentation and Anterior Interbody Fusion for Tuberculous Kyphosis of Dorsal and Lumbar Spines. Spine (Phila Pa 1976), 21, 1840-1841.

[29]   Moon, M.S., Woo, Y.K., Lee, K.S., Ha, K.Y., Kim, S.S. and Sun, D.H. (1995) Posterior Instrumentation and Anterior Interbody Fusion for Tuberculous Kyphosis of Dorsal and Lumbar Spines. Spine (Phila Pa 1976), 20, 1910-1916.
http://dx.doi.org/10.1097/00007632-199509000-00013

[30]   Emery, S.E., Chan, D.P. and Woodward, H.R. (1989) Treatment of Hematogenous Pyogenic Vertebral Osteomyelitis with Anterior Debridement and Primary Bone Grafting. Spine (Phila Pa 1976), 14, 284-291.

 
 
Top