Post-infectious ankylosis of the cervical spine in an army veteran: a case report
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CASE REPORT
Open Access
Post-infectious ankylosis of the cervical spine in an army veteran: a case report Zachary A. Cupler1* , Michael T. Anderson1, Eric T. Stefanowicz2 and Chad D. Warshel2
Abstract Background: Vertebral osteomyelitis is a rare, life-threatening condition. Successful management is dependent on prompt diagnosis and management with intravenous antibiotic therapy or surgery in addition to antibiotics. Reoccurrence is minimal after 1 year. However, very little is reported in the conservative spine literature regarding the long-term follow-up and the changes to the spine following management of the spinal infection. We report the dramatic radiologic findings of the long-term sequela of a cervical spine infection following a gunshot wound from 1969. Most impressive to the spine specialist is this patient’s ability to return to work despite significant alterations to spinal biomechanics. Case presentation: A 69 year-old caucasian male presented to the chiropractic clinic at a Veterans Affairs Medical Center with complaint of chronic left shoulder pain secondary to an associated full thickness tear of the left infraspinatus. An associated regional assessment of the cervical spine ensued. Radiological imaging on file revealed ankylosis C2/C3 to C7/T1. The patient reported a history of multiple fragment wounds in 1969 to the left anterior neck and shoulder 45 years earlier. Osteomyelitis of the cervical spine resulted from the wounds. Conclusion: Potential sequela of osteomyelitis is ankylosis of affected joints. In this particular case, imaging provides evidence of regional ankylosis of the cervical spine. Considering the patient did not complain of cervical pain or related symptoms apart from lack of cervical range of motion, and his Neck Disability Index score was 2 out of 50 (4%), no intervention was provided to the cervical spine. The patient reported he self-managed well, worked full-time as a postal worker after he was discharged due to the injury to his neck, and planned to retire in less than one month at age 70. The patient demonstrates successful return to work with pending retirement at age 70 following spondylodiscitis and subsequent ankylosis of the cervical region. Keywords: Ankylosis, Cervical, Veteran, Military personnel, Osteomyelitis, Spondylodiscitis
Background Spondylodiscitis, or vertebral osteomyelitis (VO), is specifically an infection of the spine, primarily the intervertebral disc and adjacent vertebral bodies. Prompt diagnosis is necessary for improved outcomes whether managed with antibiotics, surgery, or a combination of both. The majority of spondylodiscitis cases are treated conservatively with 10–20% managed surgically [1]. Surgical management is indicated in cases when there is a disease reoccurrence despite appropriate medical management with antibiotic therapy, neurological deficit, intractable pain, epidural abscess,
* Correspondence: [email protected] 1 Physical Medicine & Rehabilitative Services, VA Butler Healthcare, 353 North Duffy Road, Butler, PA 16001, US
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