Delayed surgical site infection 2 years after cervical disk arthroplasty. Case report and literature review

Area of Science:

• Neurosurgery
• Infectious Diseases
• Orthopedic Surgery

Background:

• Anterior cervical discectomy and arthroplasty are common procedures with generally low complication rates.
• Delayed surgical site infections (SSIs) are infrequent but serious complications following spinal surgery.
• Literature review identified only 7 previously reported cases of delayed SSIs after anterior cervical discectomy.

Observation:

• A patient developed a cervical prevertebral abscess 2 years after undergoing anterior cervical discectomy and arthroplasty.
• The abscess was attributed to Propionibacterium acnes, a bacterium typically associated with slower-growing infections.
• A beta-2-transferrin test, used to detect cerebrospinal fluid leaks, yielded a false positive result in this case.

Findings:

• Propionibacterium acnes can cause late-onset prevertebral abscesses years after cervical spine surgery.
• The diagnosis of delayed surgical site infections requires a high index of suspicion.
• Beta-2-transferrin testing may present false positives in infectious contexts, complicating diagnosis.

Implications:

• This case underscores the importance of considering rare infectious complications even long after spinal procedures.
• Early recognition and appropriate antibiotic treatment are crucial for managing delayed surgical site infections.
• Further research into the diagnostic challenges and management strategies for late-onset spinal infections is warranted.