A Late Infection After Occipitocervical Instrumentation - A Case Report

Abstract

Several fusion techniques involving instrumentation are implemented for the surgical treatment of certain pathological conditions of the occipitocervical junction. These surgical approaches may be associated with a number of complications including late surgical infections; the treatment of which is still disputed. In a tetraplegic patient with a history of post-traumatic os odontoideum and basilar invagination who had severe pyramidal signs; dens resection accompanied by C0-C5 fixation plus fusion with auto-grafting were performed. The patient was discharged on Day 7 after surgery with neurological improvement. Eight months after the initial procedure; he re-presented to our unit with discharge and signs of local infection at the site of surgery that were considered to be the manifestations of late instrumentation associated infection. The patient was admitted and antibiotics and hyperbaric oxygen were given for 4 weeks; with no improvement of the infection. Subsequently; surgical implants were removed. Postoperative dynamic x-ray images suggested complete fusion of C0-C3. During the follow-up period; no recurrence of infection was observed and the laboratory abnormalities returned to normal values. The treatment of occipitocervical infections after surgical instrumentation and the management of the infection risk in such cases are discussed below along with the case presentation.