Treatment of Severe Cervical Spondylodiscitis with Combined Anterior and Posterior Surgical Instrumentation: Case Series

Brent Zutaut*, Shari Cui MD, Taylor Shackleford MD, Sanford Emery MD
Department of Orthopaedics, West Virginia University School of Medicine, Morgantown, WV 26505

Presentation Category: Health Sciences (Poster presentation)

Student’s Major: Exercise Physiology

Purpose: Cervical spondylodiscitis (CS) is a condition recognized for significant morbidity and disability. Surgical treatments vary based on the presence and extent of neurologic compromise and structural instability. Severe cases often require combined anterior and posterior (AP) surgical intervention. This case series describes one institution’s experience with treatment of CS with AP surgery. Methods: A retrospective chart review was performed to identify patients treated with AP surgery for cervical spine infection at Ruby Memorial Hospital between 2011 and 2019. Exclusion criteria included noninfectious etiologies and ages under 18. Demographics, comorbidities, lab results, surgical data, and the need for revision were collected for each patient. Descriptive statistics, logistic regression, and chi-square analysis were performed on the data. Results: Eighteen patients met inclusion criteria. The average age was 48.8 +/- 11.5 years. Eleven were male and seven were female. Eight patients actively used intravenous drugs, six had diabetes, and six had hepatitis C. Five patients required revision for prior surgeries: two for postoperative infection of cervical hardware and three for failed prior stand-alone anterior surgery. One patient with index AP surgery required revision for recurrent infection.Conclusion: CS is a complex condition affecting patients with multiple comorbidities. In this series, all AP operations demonstrated structural and neurological durability while three revisions of prior stand-alone anterior surgery were required. A more biomechanically stable construct at the index surgery may be preferable to prevent failure. More work is needed to compare risk factors for failure and specific outcomes of combined AP procedures for CS.

Funding: Not funded

Program/mechanism supporting research/creative efforts: WVU's Research Apprenticeship Program (RAP) & accompanying HONR 297-level course