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Spinal Diskitis And Osteomyelitis As A Complication Of Head And Neck Cancer 2014

Category General Spine Allison Grayev Michael Hartman Paul Anderson Gregory Hartig Purpose To illustrate the appearance of spinal infection complicating the treatment of cancer secondary to fistula formation. Materials & Methods Three patients who developed spinal infection secondary to fistula formation during the course of treatment for malignancy will be presented. All patients had biopsy proven infection in the setting of an aerodigestive tract fistula to the spine. While one patient developed a fistula in the year following surgery, the other two patients were remote from adjuvant chemoradiation (7 years and 6 years). All infections were polymicrobial, requiring multiple antibiotics. Two patients developed infections of the cervical spine, while the other developed an infection at the T1-T2 level. Results Sagittal T1 image following gadolinium administration in demonstrates abnormal enhancement in the C5 and C6 vertebral bodies and intervening disk. This is contiguous with prevertebral phlegmon, which abuts the aerodigestive tract. There is the suggestion of a direct fistula (red arrow). While spinal infection as a complication of aerodigestive tract fistula is a known complication, the presence of coexisting comorbidities (malignancy, radiation, immunosuppression) may have an important role in the development of spine infection in this population. All patients had debridement and long term antibiotic therapy with surgical stabilization as clinically indicated. Conclusion Prompt evaluation for infection should be considered in patients who have undergone treatment for aerodigestive tract malignancy secondary to potential for direct seeding via fistula formation. Infection may occur in an immediate or delayed fashion. References Englert C, Aebert Hm Lenhart M, Solleder A, Nerlich M, Neumann C "Thoracic Spondylitis from a Mycotic (Streptococcus pneumoniae) Aortic Aneurysm" Spine 2004;29(17):E373-E375. Honda K, Asato R, Tsuji J, Kanda T, Watanabe Y, Mori Y, Tsujimura T "Pyogenic spondylodiscitis after transoral surgery for oropharyngeal cancer" Auris Nasus Larynx 2013;40:320-322. McQueen AS, Eljabu W, Latimer J, Raju PPJ "Thoracic Discitis as a Complication of Self-Expanding Metallic Stents in Esophageal Carcinoma" Cardiovasc Intervent Radiol 2011;34:S300-S302. Mecklenburg I, Probst A, Messmann H "Esophagospinal Fistula with Spondylodiscitis and Meningitis After Esophagectomy with Gastric Pull-Up" J Gastrointest Surg 2008;12:394-395.