Latent spondylodiscitis following elbow cellulitis: A case report and literature review

Abstract

Spondylodiscitis is usually caused by hematogenous spread, and recently there have been only a few published reports citing the soft tissue as the hematogenous source. We present an unusual case of pyogenic spondylodiscitis following elbow cellulitis. In addition to white blood cell (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) values, we checked the procalcitonin (PCT) level to confirm if the infection was in acute phase. Although the patient’s fever subsided after administration of antibiotics, the neurologic claudication worsened, and we performed an anterior debridement and interbody fusion combined with posterior instrumentation. The direct lateral retroperitoneal approach, which we adapted, has the advantage of excellent exposure for irrigation, debridement, and reconstruction without requiring blood vessel mobilization or manipulation of the peritoneal contents. After surgery, intravenous antibiotics were administered for 6 weeks, followed by oral antibiotics until the CRP normalized and the ESR was decreasing. The patient made an uneventful recovery, with no significant neurologic sequelae reported at outpatient follow-up evaluations. The purpose of this case report is to inform clinicians of the potentially severe complication of spondylodiscitis following cellulitis and describe a modified approach to surgical treatment.