Cervical Spondylodiscitis with Neurologic Deterioration after Percutaneous Cervical Nucleoplasty

Abstract

Percutaneous cervical nucleoplasty (PCN) has proven to be a safe and effective technique for the management of the cervical herniated or bulging discs. The incidence of cervical spondylodicitis (CSD) after PCN is rare. Case 1: A 53-year-old male patient was admitted with right arm motor weakness, severe posterior neck pain. He diagnosed with a C5-6 bulging disc and underwent a PCN two months prior to admission to our hospital. Laboratory tests revealed WBC counts and CRP levels, but his erythrocyte ESR was mildly elevated to 42 mm/hr. MRI showed a CSD at the C5-6 level. The patient underwent an anterior cervical C5 corpectomy and fusion. A microbiological culture revealed the presence of Propionibacterium acnes. Case 2: A 51-year-old female patient was admitted with quadriparesis. She was diagnosed with a C6-7 bulging disc and underwent a PCN two weeks prior to admission to our hospital. Laboratory tests revealed and elevated WBC count of 13.1×10 3 /mm 3 , elevated ESR of 70 mm/hr, and elevated CRP of 10.1 mg/dL. The MRI showed a high signal intensity around the C5-6 vertebral body and epidural fluid collection on the axial image. The patient underwent a C6-7 anterior cervical discectomy and. No microbes were identified in blood or pus cultures. Clinicians should consider CSD, if a patient's neurologic symptoms have deteriorated within 8 weeks after PCN. If clinical and laboratory tests show any indication of CSD, MRI should be performed facilitating appropriately timed treatment in order to prevent neurological sequelae.