However, late infections may also occur, which are mainly associated with an esophageal perforation, and occasionally associated with implant migration, Zenker’s diverticulum, or bacterial seeding from other surgical site or bacteremia. Literature search indicated that overall wound infection rate following ACDF is very low with a range of 0.1–1.6%, and most infections occur in the early postoperative period as a result of intraoperative bacterial seeding or postoperative poor wound care. The most common complication was postoperative dysphagia (9.5%) followed by postoperative hematoma (5.6%), symptomatic recurrent laryngeal nerve palsy (3.1%), dural penetration (0.5%), esophageal perforation (0.3%), worsening of preexisting myelopathy (0.2%), Horner’s syndrome (0.1%), instrumentation back-out (0.1%), and superficial wound infection (0.1%). In a retrospective study, it has been reported that overall morbidity rate of adverse events after ACDF was 19.3% and mortality rate was 0.1%. This case suggested that deep cervical infection should be considered if a patient had history of ACDF even in the absence of esophageal perforation.Īnterior cervical discectomy and fusion (ACDF) procedure has been widely performed for degenerative disc disease, traumatic cervical diseases, or cervical spondylosis. His cervial spine was stablized 11 months after the surgery with support of external Hallo Frame. The patient’s deep cervical infection was healed 3 months after debridement and antibiotic administration. In addition, an external Hallo frame was used to support unstable cervical spine. Staphylococcus aureus was positively cultured from the abscess drainage, for which appropriate antibiotics including cefoxitin, vancomycin, levofloxacin, and cefoperazone were administered postoperatively. The abscess was managed through radical neck dissection approach with repated washing and removal of the titanium implant. The patient did not have esophageal perforation. Here, we report a case of 59-year-old male patient who developed deep cervical abscess 30 days after anterior cervical discectomy and titanium cage bone graft fusion (autologous bone) at C3/4 and C4/5. While this procedure is highly successful, 0.1–1.6% of early and late postoperative infection have been reported although the rate of late infection is very low. Anterior cervical discectomy and fusion (ACDF) is often performed for the treatment of degenerative cervical spine.
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