Case report: a rare combination of diffuse idiopathic skeletal hyperostosis and cervical septic spondylodiscitis

Abstract

Ossification of the anterior longitudinal ligament of the spine is a rare pathology with still unclear etiopathogenesis, although some authors associate it with metabolic diseases such as diabetes. Another rare disorder whose etiopathogenesis is also closely related to immunological disorders in diabetes is spinal epidural empyema. We present a case of a 62-year-old man with comorbidities of arterial hypertension and type II diabetes mellitus, with complaints of dysphagia and throat discomfort one and a half years prior to hospitalization. About a month before hospitalization, the patient reports pain with limited cervical mobility, followed by episodes of fever up to 38°C, with developing upper extremity muscle weakness and self-care incapacity. After imaging and laboratory studies, the patient was diagnosed with Forestier disease according to Resnick and Niwayama criteria, with ossification of the anterior longitudinal ligament and spondylodiscitis with epidural empyema in the cervical compartment. The patient was started on empiric antibiotic therapy and emergency surgery was undertaken for osteophytectomy, median corpectomy with medullar decompression and vertebrodesis. Postoperatively, the patient had improvement in dysphagia and upper extremity muscle strength - MRC 5/5 at the 6-month follow-up. Timely diagnosis and operative treatment with adequate decompression, anterior vertebrodesis and subsequent targeted antibiotic therapy are essential for a good outcome in the management of patients with this combined pathology.