Postsurgical prevertebral abscess of the cervical spine.
OBJECTIVE
Prevertebral abscess formation is an uncommon occurrence following cervical spine fusion surgery. Abscesses may present early or in a delayed fashion and require surgical drainage and long-term antibiotic treatment. The issues of osteomyelitis and the need for plate removal remain unresolved.


METHODS
A case series of six tetraplegic patients admitted for rehabilitation to the Chaim Sheba Medical Center (Tel Hashomer, Israel) is presented.


METHODS
Five patients were trauma patients; one patient underwent repeated procedures and irradiation for tumor of the cervical spine. All patients developed prevertebral abscesses after a mean period of 30 days from their fusion surgery. Computed tomography scan was used in all patients to establish the diagnosis and define the extent of the infective process. All patients underwent one or more drainage procedures. The plate was removed in two patients at 1 and 4 months.


RESULTS
Infection completely resolved in four patient and was refractory in one patient with malignant tumor, and a chronic small fistula remained in one case. Staphylococcus aureus was the main infective organism, but mixed infections were the rule. Even for a protracted course of infection, no significant osteomyelitis was encountered.


CONCLUSIONS
Abscess formation after instrumentation of the neck may be more common than formerly recognized. Despite the prolonged course of disease and treatment, osteomyelitis is not a major concern. There is no automatic indication for plate removal to control infection, although plating may be safely removed after 10 to 12 weeks if the neck is explored and the cervical spine is stable. A high index of suspicion is warranted, and early recognition and diagnosis, prompt surgical drainage under general anesthesia, and long-term antibiotic treatment are key for eradication of the infective process. Prophylactic antibiotics may be of value. Meticulous antisepsis and surgical technique should be maintained to reduce the incidence of these severe complications.
Talmi
Y P
YP
Department of Otolaryngology--Head and Neck Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Knoller
N
N
Dolev
M
M
Wolf
M
M
Simansky
D A
DA
Keller
N
N
Hadani
M
M
Ohry
A
A
Kronenberg
J
J
D000038:Abscess / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D013203:Staphylococcal Infections; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents