Multi-stage treatment of non-specific spondylodiscitis of the cervical spine

The objective is to present a clinical case of successful treatment of a patient with recurrent spondylitis at the cervical level.

Clinical case. A 65-year-old patient was diagnosed with purulent spondylodiscitis at the level of C₆-C₇ vertebrae with the epidural and paravertebral abscesses and spinal cord compression. Emergency left colotomy, paravertebral abscess dissection, corporectomy of the C₆ vertebra, abscess removal, anterior spondylodesis with bone autograft and titanium plate were performed. Massive antibacterial therapy was prescribed. After the operation, the volume of movement in the left limbs was restored, and on the 15^th day after the operation, the patient was discharged. On the 36^th day after discharge, she was hospitalized again with hematuria. A recurrence of suppuration in the area of the operation and phlegmon of both feet was revealed. Revision of the surgical wound and rehabilitation of the purulent focus on the neck, surgical intervention for phlegmon were performed. In purulent foci, Staphylococcus aureus was verified, which is sensitive to the main antibacterial drugs. Antibacterial therapy was continued, then, after changing the microflora in the wound, other antibiotics were prescribed. There was a pain in the area of the left spinal root C₅. The connection of the fistula course with the titanium plate, the increase of pathological kyphosis at the level of the overlying vertebrae was found. The wound was examined, the titanium plate was removed, and the halo device was applied to correct the pathological kyphosis. After the operation, the radicular pain syndrome regressed, and the axis of the cervical spine was restored. After 1 month, the posterior combined fixation of the cervical spine at the C₃-Th₇ level was performed, and the halo device was dismantled. After 6 months, the patient was stopped wearing the Philadelphia neck collar, no recurrence of suppuration was observed, and a complete regression of neurological disorders was noted. After 1 year, a complete bone block is preserved between the C₄-C₇ vertebrae.

Conclusion. The presented clinical case clearly illustrates the complexity of managing patients with inflammatory diseases of the cervical spine. Currently, there is no single treatment strategy for patients with spondylitis.

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