Espondilodiscitis cervical…(Inglés)

Andrea Bolzoni, MD 1, Giorgio Peretti, MD 1, Cesare Piazza, MD 1, Davide Farina, MD 2, Piero Nicolai, MD 1 *

1Department of Otorhinolaryngology, University of Brescia, Spedali Civili, Piazza Spedali Civili 1, 25123 Brescia, Italy 2Institute of Radiology, University of Brescia, Brescia, Italy

email: Piero Nicolai (pieronicolai@virgilio.it)

Keywords cervical spondylodiscitis • tracheoesophageal puncture • phonatory prosthesis • complication

Abstract

Background. Tracheoesophageal puncture has excellent voice rehabilitation after total laryngectomy. However, despite its easy insertion and use, severe complications have been reported.

Methods. We report a case of cervical spondylodiscitis, occurring in a 67-year-old woman submitted to phonatory prosthesis insertion. After 1 month, she complained of severe cervicalgia associated with fever. Spondylodiscitis involving C6, C7, and the intervening vertebral disk with medullary compression was detected by means of imaging studies.

Results. A right cervicotomy with drainage of necrotic tissue was performed, and a deepithelialized fasciocutaneous deltopectoral flap was interposed between the neopharynx-esophagus and the prevertebral fascia to protect the neurovascular axis. MR performed 1 month later showed a complete resolution of the infectious process.

Conclusions. Severe neck pain after tracheoesophageal puncture should alert the physician about the possibility of a cervical spondylodiscitis. MR is the most useful imaging technique for preoperative and postoperative evaluation. When neurologic symptoms are detected, surgical exploration of the neck is mandatory.