Concomitant Pyogenic Atlantoaxial Spondylodiscitis with Retropharyngeal Abscesses and Tuberculous Spondylodiscitis with Gibbus Deformity: A Combined Rare Condition-A Case Report and Literature Review.

Abstract

Concomitant pyogenic atlantoaxial spondylodiscitis alongside retropharyngeal abscesses, in conjunction with tuberculous spondylodiscitis manifesting as gibbus deformity, represents a rare but significant clinical entity. This dual infectious process poses considerable risks and can lead to severe, life-threatening complications if not appropriately managed. We present an atypical case of a 6-year-old Thai boy with concurrent pyogenic atlantoaxial spondylodiscitis, retropharyngeal abscesses, and tuberculous spondylodiscitis at the T6 to T8 levels, leading to a progressive kyphotic deformity. The surgical treatment involved transoral drainage of the abscesses, followed by debridement and vertebral column resection at T6 to T8. A titanium mesh cage was placed, and instrumentation from T3 to T11 was performed using pedicle screws and rods. Postoperatively, the patient showed favorable recovery, with the Cobb angle improving from 70 to 16 degrees. He received intravenous antibiotics for 2 weeks, then oral antibiotics for 4 weeks, along with 12 months of antituberculous chemotherapy. Over a 2-year follow-up period, the patient exhibited clinically significant improvement, and postoperative radiographs confirmed solid osseous fusion with no indications of loss of correction or implant failure. Concomitant pyogenic atlantoaxial spondylodiscitis with retropharyngeal abscess formation, alongside tuberculous spondylodiscitis leading to gibbus deformity, constitutes a rare yet serious clinical scenario. If not addressed promptly, the condition carries substantial risks, such as airway obstruction, sepsis, and potential neurological impairments. Management strategies should prioritize the elimination of infectious agents, prevention of neurological compromise, stabilization of the spinal column, and correction of kyphotic deformities.