array:23 [
  "pii" => "S113014731830023X"
  "issn" => "11301473"
  "doi" => "10.1016/j.neucir.2018.02.004"
  "estado" => "S300"
  "fechaPublicacion" => "2019-03-01"
  "aid" => "322"
  "copyright" => "Sociedad Española de Neurocirugía"
  "copyrightAnyo" => "2018"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "crp"
  "cita" => "Neurocirugia. 2019;30:81-6"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 12
    "formatos" => array:2 [
      "HTML" => 8
      "PDF" => 4
    ]
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S1130147318300241"
    "issn" => "11301473"
    "doi" => "10.1016/j.neucir.2018.02.005"
    "estado" => "S300"
    "fechaPublicacion" => "2019-03-01"
    "aid" => "323"
    "copyright" => "Sociedad Española de Neurocirugía"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Neurocirugia. 2019;30:87-93"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 19
      "formatos" => array:2 [
        "HTML" => 12
        "PDF" => 7
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>"
      "titulo" => "Symptomatic delayed coil migration after balloon assisted embolization&#58; An underreported adverse event&#63;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "87"
          "paginaFinal" => "93"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Migraci&#243;n Sintom&#225;tica Tard&#237;a de Coil tras Embolizaci&#243;n Asistida con Bal&#243;n&#58; &#191;un evento adverso infra descrito&#63;"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0020"
          "etiqueta" => "Fig&#46; 4"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr4.jpeg"
              "Alto" => 602
              "Ancho" => 1298
              "Tamanyo" => 65079
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Cerebral angiography&#44; internal carotid artery injection&#44; oblique projection demonstrated migration of 2 coil loops&#44; one to calloso-marginal branch and the other to pericallosal branch of the right anterior cerebral artery&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Lino Fonseca, Rafael Najarro-Quispe, Ana Rodr&#237;guez-Hern&#225;ndez, Ramon Torn&#233;, Dario G&#225;ndara-Sabatini, Fuat Arikan, Pilar Ba&#241;os-Carrasco"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "Lino"
              "apellidos" => "Fonseca"
            ]
            1 => array:2 [
              "nombre" => "Rafael"
              "apellidos" => "Najarro-Quispe"
            ]
            2 => array:2 [
              "nombre" => "Ana"
              "apellidos" => "Rodr&#237;guez-Hern&#225;ndez"
            ]
            3 => array:2 [
              "nombre" => "Ramon"
              "apellidos" => "Torn&#233;"
            ]
            4 => array:2 [
              "nombre" => "Dario"
              "apellidos" => "G&#225;ndara-Sabatini"
            ]
            5 => array:2 [
              "nombre" => "Fuat"
              "apellidos" => "Arikan"
            ]
            6 => array:2 [
              "nombre" => "Pilar"
              "apellidos" => "Ba&#241;os-Carrasco"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147318300241?idApp=UINPBA00004B"
    "url" => "/11301473/0000003000000002/v1_201902260607/S1130147318300241/v1_201902260607/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S113014731830109X"
    "issn" => "11301473"
    "doi" => "10.1016/j.neucir.2018.11.003"
    "estado" => "S300"
    "fechaPublicacion" => "2019-03-01"
    "aid" => "357"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Neurocirugia. 2019;30:77-80"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 115
      "formatos" => array:2 [
        "HTML" => 95
        "PDF" => 20
      ]
    ]
    "es" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Art&#237;culo especial</span>"
      "titulo" => "Llamada para participar en el estudio internacional de resultados del traumatismo craneoencef&#225;lico <span class="elsevierStyleItalic">&#40;Global Neurotrauma Outcomes Study&#41;</span>"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "77"
          "paginaFinal" => "80"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Call to participate in the international study of traumatic brain injury results &#40;Global Neurotrauma Outcomes Study&#41;"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Irene Panero P&#233;rez, Ana-Mar&#237;a Casta&#241;o Le&#243;n, Mar&#237;a Luisa Gand&#237;a Gonz&#225;lez, Angelos Kolias"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Irene"
              "apellidos" => "Panero P&#233;rez"
            ]
            1 => array:2 [
              "nombre" => "Ana-Mar&#237;a"
              "apellidos" => "Casta&#241;o Le&#243;n"
            ]
            2 => array:2 [
              "nombre" => "Mar&#237;a Luisa"
              "apellidos" => "Gand&#237;a Gonz&#225;lez"
            ]
            3 => array:2 [
              "nombre" => "Angelos"
              "apellidos" => "Kolias"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2529849619300036"
        "doi" => "10.1016/j.neucie.2018.11.003"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529849619300036?idApp=UINPBA00004B"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S113014731830109X?idApp=UINPBA00004B"
    "url" => "/11301473/0000003000000002/v1_201902260607/S113014731830109X/v1_201902260607/es/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>"
    "titulo" => "Delayed surgical site infection 2 years after cervical disk arthroplasty&#46; Case report and literature review"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "81"
        "paginaFinal" => "86"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Aleix Rossell&#243;, Jose Luis Sanmill&#225;n, Luis L&#243;pez-Obarrio, Iv&#225;n Pelegr&#237;n, Andreu Gabarr&#243;s, Oscar Godino"
        "autores" => array:6 [
          0 => array:4 [
            "nombre" => "Aleix"
            "apellidos" => "Rossell&#243;"
            "email" => array:1 [
              0 => "a&#46;rossello&#64;bellvitgehospital&#46;cat"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Jose Luis"
            "apellidos" => "Sanmill&#225;n"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Luis"
            "apellidos" => "L&#243;pez-Obarrio"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Iv&#225;n"
            "apellidos" => "Pelegr&#237;n"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Andreu"
            "apellidos" => "Gabarr&#243;s"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Oscar"
            "apellidos" => "Godino"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Neurosurgery Department&#44; Hospital Universitari de Bellvitge&#44; L&#8217;Hospitalet de Llobregat&#44; Barcelona&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Infectious Diseases Department&#44; Hospital Universitari de Bellvitge&#44; L&#8217;Hospitalet de Llobregat&#44; Barcelona&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Infecci&#243;n diferida del sitio quir&#250;rgico 2 a&#241;os despu&#233;s de la artroplastia de disco cervical&#46; Caso cl&#237;nico y revisi&#243;n de la literatura"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1232
            "Ancho" => 950
            "Tamanyo" => 112810
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Barium swallow&#46; Barium swallow&#44; showing left displacement and constriction of the esophagus&#44; with no pass of contrast into the cavity&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Anterior cervical discectomy and fusion &#40;or disk arthroplasty&#41; has a low complication rate&#44; with a reported infection rate lower than 3&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1&#44;2</span></a> Most surgical site infections &#40;SSI&#41; occur in the early postoperative period&#46; Delayed SSI&#44; defined as occurring after 3 months from surgery&#44; is a very rare complication&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> We report a case of delayed prevertebral cervical abscess diagnosed 2 years after two-level cervical arthroplasty&#44; discuss the diagnosis and etiology&#44; and review the literature&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 55 years-old male consulted for a right cervical mass that had been slowly growing for eight weeks&#46; Past medical history included high blood pressure&#44; hyperlipidemia&#44; smoking and alcoholic hepatopathy&#46; Two years before&#44; the patient was treated of disk herniation in another center&#44; with C4&#8211;C5&#8211;C6 discectomy and arthroplasty &#40;M6-C&#44; Spinal Kinetics&#44; Sunnyvale&#44; CA&#44; USA&#41;&#44; with an uneventful postoperative period&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Physical examination revealed a fluctuant and tight right laterocervical mass&#44; without fever&#44; dysphagia&#44; dyspnea or neurological deficits&#46; Estimated sedimentation rate &#40;ESR&#41; was 20<span class="elsevierStyleHsp" style=""></span>mm&#47;h&#44; C-reactive protein was &#40;CRP&#41; &#60;1<span class="elsevierStyleHsp" style=""></span>mg&#47;dL and white blood cell &#40;WBC&#41; count was 6500&#47;mm<span class="elsevierStyleSup">3</span> with 60&#37; of neutrophils&#46; Human immunodeficiency virus test was negative&#46; Flexible laryngeal and esophageal endoscopy revealed an extrinsic laryngeal constriction but no intraluminal pathology&#46; CT scan showed a right cervical prevertebral hypodens mass with mild peripheral iodine contrast enhancement at C4&#8211;D2 level &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; MR revealed a T1WI hypointense and T2WI and STIR hyperintense mass &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The barium swallow did not show pass of contrast into the cavity &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Our primary diagnosis was delayed SSI because of the patient&#39;s risk factors&#46; However&#44; due to the slow growing of the collection&#44; we could not exclude tuberculosis or post-surgical pseudomeningocele because of the lack of systemic inflammatory reaction and MR findings&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Finally&#44; owing to slow but continuous mass enlargement&#44; an ultrasound guided puncture was performed&#44; obtaining pus&#44; but it did not provide enough evacuation neither microbiological diagnosis&#46; Consequently&#44; we indicated surgical exploration&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Intraoperatively&#44; we found a capsulated cavity containing pus that extended to the prevertebral space in contact with the prostheses&#44; without any associated tracheal or esophageal lesion&#46; After abscess debridement&#44; prostheses were removed and substituted for iliac crest bone graft &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#44; and rifampicin was instilated&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">We actively looked for a cerebrospinal fluid leak&#44; aided by Valsalva maneuver&#44; but we could not demonstrate it&#46; In order to rule out a pseudomeningocele&#44; we performed beta-2-transferrine test&#46; It yielded a positive result but&#44; as later discussed&#44; we assumed it as a false positive&#46; The bacterial culture and polymerase chain reaction analysis &#40;PCR&#41; were positive for <span class="elsevierStyleItalic">Propionibacterium acnes</span>&#44; so antibiotic was adjusted from vancomycin and meropenem to amoxicillin-clavulanate 1<span class="elsevierStyleHsp" style=""></span>g every 8<span class="elsevierStyleHsp" style=""></span>h for 6 weeks&#46; The postoperative period was uneventful&#46; At 6 months follow-up&#44; the patient remained asymptomatic&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">Anterior cervical discectomy is a common procedure with a low infection rate&#44; being most of them during the early postoperative period&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1&#44;2</span></a> In our literature review we found 7 cases of delayed SSI&#44; defined as infection occurring after 3 months from surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Bhise<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a> reported a patient with fever and pus-discharging sinus over the posterior triangle of the neck&#44; without any cavitation around the fused segment&#44; and suggested a low-grade infection at implant site as the probable etiology&#46; Christiano<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a> reported a case that presented with dysphagia and fever secondary to a prevertebral abscess&#44; and stated the cause of infection was elusive&#46; Hur<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a> presented a case of neck pain and progressive spinal cord syndrome due to an epidural abscess and proposed micro injury of esophagus due to implants as a causal factor&#46; Jin<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> reported a patient who consulted for blood-tinged sputum and a laryngeal mass&#44; CT and MR revealed a prevertebral abscess associated to osteomyelitis&#44; and they reported the cause of infection as elusive&#46; Kuriloff<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> published a case of a patient who consulted for dysphagia&#44; cervical inflammation and fever&#44; whose CT revealed a prevertebral abscess&#44; and that was secondary to an esophageal fistula&#46; Tsitsopoulos<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a> presented a patient with dysphagia and pus draining from incision due to a fistula from prevertebral space&#44; and suggested it may have originated from the newly formed bone at the fusion site&#46; Violon<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a> reported a case of neck pain and dysphagia due to prevertebral abscess and stated an insidious esophageal wall perforation might be evoked as the possible source of the infection&#46; All cases had a good outcome after surgical revision and antibiotherapy&#44; except the patient reported by Hur&#44;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a> who died due to sepsis&#46; See <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> for a detailed review of these reported cases&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">In these reported cases&#44; the predominant microbiological isolation was <span class="elsevierStyleItalic">Streptococcus</span> spp&#46;&#44; associated to 1 case of <span class="elsevierStyleItalic">Veilonella</span> spp&#46; and 2 of <span class="elsevierStyleItalic">Peptostreptococcus</span> spp&#46;&#44; which are members of the salivary and gut microbiome&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">We could not find a common pattern between clinical manifestation&#44; blood test results&#44; type of implant and associated osteomyelitis in these patients with delayed SSI&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Different causes of delayed SSI are proposed among reported cases&#58; low grade infection at implant site&#44; microinjury of esophagus&#44; definite esophageal fistula&#44; fistulation to skin from the newly formed bone at fusion site&#44; but infection was also reported as elusive in 2 cases&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Regarding treatment options&#44; in all cases except in Tsitsopoulos&#8217;&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a> surgical debridement and removal of implants was performed&#44; followed by antibiotic adjusted by microorganism culture&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">To our knowledge&#44; this is the only report of a delayed cervical spine SSI manifesting as a slowly growing cervical mass as the only clinical manifestation without any associated inflammatory findings&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The microbiological isolation of <span class="elsevierStyleItalic">P&#46; acnes</span>&#44; confirmed by PCR assay&#44; implies some discussion&#46; First&#44; it is a member of skin and gut floras&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a> which could favor the hypotheses of either latent implant contamination or acquired and spontaneously healed esophageal microperforation&#46; Second&#44; it is known as a microfilm creator&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> which could support the latent implant contamination hypothesis&#44; and favors surgical removal of implants&#46; Third&#44; the patient underwent arthroplasty instead of fusion&#44; which raises the question if the different implant properties could be a risk factor for a delayed implant-related SSI by biofilm-producing bacteria&#46; Finally&#44; it has a slow growth&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> which would justify this unusual course for a cervical abscess&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The beta-2-transferrin test is an elementary tool in the diagnosis of cerebrospinal fluid leak&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> MR findings raised the possibility of a spontaneously closed and subsequently infected pseudomeningocele&#46; Therefore&#44; we performed beta-2-transferrin test in the sample of purulent material&#46; We obtained a positive result&#44; which lead to strict control of meningeal irritation signs or cerebrospinal fluid fistula&#46; Nevertheless&#44; the lack of meningeal symptomatology&#44; the non-confirming imaging tests&#44; the intraoperative findings and the neuraminidase secretion of most of <span class="elsevierStyleItalic">P&#46; acnes</span> strains&#44;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a> a known cause of false-positive test due to transferrine enzymatic processing&#44;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> lead us to assume it as a false positive&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Acquired esophageal&#47;tracheal microperforation&#44; latent clinically-silent implant infection and bacteremia<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> have been described as possible causes of delayed SSI in the cervical spine&#46; In this case&#44; micro-trauma related and spontaneously healed esophageal micro-perforation could not be completely ruled out&#46; Nonetheless&#44; due to <span class="elsevierStyleItalic">P&#46; acnes</span> slow growth and microfilm formation&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> a latent implant infection was the infection cause we assumed&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusion</span><p id="par0085" class="elsevierStylePara elsevierViewall">We report an illustrative case of a delayed cervical paravertebral abscess following uneventful cervical disk arthroplasty&#46; Our patient presented with a slowly growing paravertebral abscess appearing 2 years after cervical surgery without any inflammatory parameters&#46; Delayed SSI is a rare but potentially severe complication after anterior cervical discectomy&#46; Revision surgery is almost always required followed by long-course antibiotic treatment&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflicts of interest and source of funding</span><p id="par0090" class="elsevierStylePara elsevierViewall">The manuscript submitted does not contain information about medical device&#40;s&#41;&#47;drug&#40;s&#41;&#46; No funds were received in support of this work&#46; No benefits in any form have been or will be received related directly or indirectly to the subject of this manuscript&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The present research has not received any specific scholarship from public&#44; commercial&#44; or non-profit agencies&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:12 [
        0 => array:3 [
          "identificador" => "xres1155375"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1082929"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "xpalclavsec1082931"
          "titulo" => "Abbreviations"
        ]
        3 => array:3 [
          "identificador" => "xres1155374"
          "titulo" => "Resumen"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        4 => array:2 [
          "identificador" => "xpalclavsec1082930"
          "titulo" => "Palabras clave"
        ]
        5 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        6 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Case report"
        ]
        7 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Conclusion"
        ]
        9 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Conflicts of interest and source of funding"
        ]
        10 => array:2 [
          "identificador" => "xack394298"
          "titulo" => "Acknowledgements"
        ]
        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-10-26"
    "fechaAceptado" => "2018-02-15"
    "PalabrasClave" => array:2 [
      "en" => array:2 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1082929"
          "palabras" => array:6 [
            0 => "Cervical disk arthroplasty"
            1 => "Delayed infection"
            2 => "Surgical site infection"
            3 => "Cervical abscess"
            4 => "Beta-2-transferrin"
            5 => "Neuraminidase"
          ]
        ]
        1 => array:4 [
          "clase" => "abr"
          "titulo" => "Abbreviations"
          "identificador" => "xpalclavsec1082931"
          "palabras" => array:9 [
            0 => "BOP"
            1 => "CRP"
            2 => "CSF"
            3 => "CT"
            4 => "ESR"
            5 => "MR"
            6 => "PCR"
            7 => "SSI"
            8 => "WBC"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1082930"
          "palabras" => array:6 [
            0 => "Artroplastia cervical"
            1 => "Infecci&#243;n diferida"
            2 => "Infecci&#243;n del sitio quir&#250;rgico"
            3 => "Absceso cervical"
            4 => "Beta-2-transferrina"
            5 => "Neuraminidasa"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Anterior cervical discectomy has a low non-mechanical complication rate&#46; In our literature review&#44; we found 7 cases of delayed surgical site infection&#46; We report a case of cervical prevertebral abscess due to <span class="elsevierStyleItalic">Propionibacterium acnes</span> 2 years after discectomy and arthroplasty&#44; with a beta-2-transferrin false positive test as a complementary highlighted finding&#46; We discuss the diagnosis and etiology of this rare delayed infectious complication&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La discectom&#237;a cervical anterior tiene una baja tasa de complicaciones no mec&#225;nicas&#46; En la revisi&#243;n de la literatura&#44; encontramos 7 casos de infecci&#243;n diferida del sitio quir&#250;rgico&#46; Presentamos un caso de absceso cervical prevertebral secundario a <span class="elsevierStyleItalic">Propionibacterium acnes</span> 2 a&#241;os despu&#233;s de la cirug&#237;a&#44; asociado a un falso positivo del test de beta-2-transferrina como hallazgo complementario a destacar&#44; y discutimos el diagn&#243;stico y la etiolog&#237;a de esta rara complicaci&#243;n infecciosa diferida&#46;</p></span>"
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1625
            "Ancho" => 1200
            "Tamanyo" => 140217
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">CT and MR&#46; &#40;A&#41; Iodine contrast-enhanced CT scan&#44; showing a right cervical prevertebral hypodense mass with mild peripheral contrast enhancement&#46; &#40;B&#41; Sagittal cervical spine MR&#44; showing a T1 hypointense mass&#46; &#40;C&#41; Sagital cervical spine MR&#44; showing a T2 hyperintense mass&#44; suggestive of either cerebrospinal fluid collection or abscess&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1232
            "Ancho" => 950
            "Tamanyo" => 112810
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Barium swallow&#46; Barium swallow&#44; showing left displacement and constriction of the esophagus&#44; with no pass of contrast into the cavity&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Fig&#46; 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 517
            "Ancho" => 1800
            "Tamanyo" => 110118
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Pre- and intraoperative pictures of the abscess&#46; &#40;A&#41; Lateral view&#46; &#40;B&#41; Anterior view&#46; &#40;C&#41; Aspiration of abscess content&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reference&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Age&#44; gender&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Time from surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Past medical history&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Presentation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Blood test&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Imaging diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Type of implant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Surgical treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Microbiology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Osteomyelitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Antibiotic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Etiological diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Outcome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bhise<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30 y&#44; male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Unremarkable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pus discharging from sinus over the posterior triangle of neck and fever&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">High ESR and CRP&#46; HIV negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CT&#58; single screw fixation with evidence of fusion without vertebral destruction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fibular bone graft and buttress screw fixation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Screw removal&#44; debridement and saline washing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Beta-hemolytic <span class="elsevierStyleItalic">Streptococci</span> sensitive to linezolid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cefuroxime and amikacin for 5 days&#44; followed by Linezolid for 5 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Low-grade infection at implant site&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Christiano<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52 y&#44; female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Unremarkable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dysphagia and fever&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">WBC 11&#46;7&#44; ESR 32&#44; and CRP 91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CT&#58; abscess anterior to the fusion plate<br>Barium-swallow study&#58; normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Unicortical c allograft and plate-screw&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Instrumentation removal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Streptococcus intermedius</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Clindamycin for 6 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Elusive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hur<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68 y&#44; male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14<span class="elsevierStyleHsp" style=""></span>m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Unremarkable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Progressive paraparesis&#44; urinary retention and posterior neck pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">High ESR&#44; CRP and WBC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">X-ray and CT&#58; graft extrusion&#44; screw loosening&#44; gas collection<br>MRI&#58; spinal epidural abscess&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Allograft and plate-screw construction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Instrumentation removal&#44; corpectomy&#44; debridement and saline washing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Streptococcus anginosus</span><br>MRSA&#44; and <span class="elsevierStyleItalic">K&#46; pneumoniae</span> in 2nd surgical samples&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Vancomycin immediately after surgery&#44; Ceftriaxone<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>Metronidazole after <span class="elsevierStyleItalic">S&#46; anginosus</span> isolation&#44; Vancomycin and Meropenem after MRSA and <span class="elsevierStyleItalic">K&#46; pneumonia</span> isolation&#44; and Linezolid after meningitis was diagnosed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Micro injury of esophagus due to implants&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Death due to sepsis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Jin<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">74 y&#44; male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Unremarkable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bloody sputum and laryngeal mass&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Normal ESR&#44; CRP and WBC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">X-ray&#58; destruction of C4 and C5 bodies&#46;<br><br>CT and MRI&#58; enhancing and destructive lesion at C4&#8211;5 disk space with anterior protrusion to the prevertebral and retropharyngeal spaces&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Biocompatible osteoconductive polymer &#40;BOP&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Abscess debridement&#44; C4 corpectomy and ACDF at C3&#8211;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Flomoxef&#44; Netilmicin&#44; Metronidazole for 11 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Elusive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kuriloff<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38 y&#44; female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4<span class="elsevierStyleHsp" style=""></span>m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rheumatoid spondylitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dysphagia&#44; cervical inflammation and fever&#44; appearing 4 months after C7-T1 osteotomies and halo to correct flexion deformity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">WBC 12&#44;400&#47;mm<span class="elsevierStyleSup">3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CT&#58; large prevertebral abscess&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Plate and screw fixation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Abscess debridement&#44; instrumentation removal and esophageal reparation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Peptococcus</span> and <span class="elsevierStyleItalic">P&#46; aeruginosa</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Piperacillin and tobramycin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Esophageal fistula&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tsitsopoulos<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60 y&#44; female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dysphagia and pus draining from incision&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MRI&#58; fistula from anterior part of C6 body to the skin<br>Esophagoscopy and barium swallow&#58; normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Iliac crest bone&#44; cage&#44; and plate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fistula excision&#46; No removal of implants&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fistula may have originated from the newly formed bone at the fusion site&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Violon<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44 y&#44; female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Neck pain and dysphagia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Normal ESR&#44; CRP and WBC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CT&#58; thickening of the prevertebral tissues<br>MRI&#58; signal abnormalities in the two adjacent vertebral bodies&#44; and marked and homogeneous enhancement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Synthetic biocopolymer &#40;BOP&#41; graft&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Granulomatous tissue and BOP graft resection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">S&#46; anginosus&#44; S&#46; intermedius&#44; Veilonella parvula</span> and <span class="elsevierStyleItalic">Peptostreptococcus anaerobius</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Clindamycin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Spontaneously closed&#44; clinically latent&#44; insidious oesophageal perforation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1972390.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Overview of 7 reported cases of anterior cervical spine delayed SSI&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:15 [
            0 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Perioperative and delayed complications associated with the surgical treatment of cervical spondylotic myelopathy based on 302 patients from the AOSpine North America Cervical Spondylotic Myelopathy Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46;G&#46; Fehlings"
                            1 => "J&#46;S&#46; Smith"
                            2 => "B&#46; Kopjar"
                            3 => "P&#46;M&#46; Arnold"
                            4 => "S&#46;T&#46; Yoon"
                            5 => "A&#46;R&#46; Vaccaro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3171/2012.1.SPINE11467"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Neurosurg Spine"
                        "fecha" => "2012"
                        "volumen" => "16"
                        "paginaInicial" => "425"
                        "paginaFinal" => "432"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22324802"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Anterior cervical discectomy and fusion associated complications"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "K&#46;N&#46; Fountas"
                            1 => "E&#46;Z&#46; Kapsalaki"
                            2 => "L&#46;G&#46; Nikolakakos"
                            3 => "H&#46;F&#46; Smisson"
                            4 => "K&#46;W&#46; Johnston"
                            5 => "A&#46;A&#46; Grigorian"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/BRS.0b013e318154c57e"
                      "Revista" => array:5 [
                        "tituloSerie" => "Spine &#40;Phila Pa 1976&#41;"
                        "fecha" => "2007"
                        "volumen" => "32"
                        "paginaInicial" => "2310"
                        "paginaFinal" => "2317"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Infection with spinal instrumentation&#58; review of pathogenesis&#44; diagnosis&#44; prevention&#44; and management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;K&#46; Kasliwal"
                            1 => "L&#46;A&#46; Tan"
                            2 => "V&#46;C&#46; Traynelis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/2152-7806.120783"
                      "Revista" => array:7 [
                        "tituloSerie" => "Surg Neurol Int"
                        "fecha" => "2013"
                        "volumen" => "4"
                        "numero" => "Suppl 5"
                        "paginaInicial" => "S392"
                        "paginaFinal" => "S403"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24340238"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Late prevertebral abscess with sinus following anterior cervical corpectomy and fusion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46; Bhise"
                            1 => "A&#46; Mathesul"
                            2 => "P&#46; Deokate"
                            3 => "A&#46; Chandanwale"
                            4 => "G&#46; Bartakke"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/1793-5482.161172"
                      "Revista" => array:5 [
                        "tituloSerie" => "Asian J Neurosurg"
                        "fecha" => "2015"
                        "volumen" => "10"
                        "paginaInicial" => "272"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26425154"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Late prevertebral abscess after anterior cervical fusion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46;D&#46; Christiano"
                            1 => "I&#46;M&#46; Goldstein"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/BRS.0b013e3181fc9b09"
                      "Revista" => array:5 [
                        "tituloSerie" => "Spine &#40;Phila Pa 1976&#41;"
                        "fecha" => "2011"
                        "volumen" => "36"
                        "paginaInicial" => "E798"
                        "paginaFinal" => "E802"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Unusual fatal infections after anterior cervical spine surgeries"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;W&#46; Hur"
                            1 => "J&#46;B&#46; Lee"
                            2 => "J&#46;H&#46; Kim"
                            3 => "S&#46;H&#46; Kim"
                            4 => "T&#46;H&#46; Cho"
                            5 => "J&#46;N&#46; Suh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.14245/kjs.2012.9.3.304"
                      "Revista" => array:6 [
                        "tituloSerie" => "Korean J Spine"
                        "fecha" => "2012"
                        "volumen" => "9"
                        "paginaInicial" => "304"
                        "paginaFinal" => "308"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25983839"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Late infection from anterior cervical discectomy and fusion after twenty years"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46;-W&#46; Jin"
                            1 => "S&#46;-H&#46; Kim"
                            2 => "J&#46;-I&#46; Choi"
                            3 => "S&#46;-K&#46; Ha"
                            4 => "D&#46;-J&#46; Lim"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.14245/kjs.2014.11.1.22"
                      "Revista" => array:6 [
                        "tituloSerie" => "Korean J Spine"
                        "fecha" => "2014"
                        "volumen" => "11"
                        "paginaInicial" => "22"
                        "paginaFinal" => "24"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24891869"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Delayed neck infection following anterior spine surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46;B&#46; Kuriloff"
                            1 => "S&#46; Blaugrund"
                            2 => "J&#46; Ryan"
                            3 => "P&#46; O&#8217;Leary"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Laryngoscope"
                        "fecha" => "1987"
                        "volumen" => "97"
                        "paginaInicial" => "1094"
                        "paginaFinal" => "1098"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3626736"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A delayed spinocutaneous fistula after anterior cervical discectomy and fusion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46;P&#46; Tsitsopoulos"
                            1 => "N&#46; Marklund"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.spinee.2014.11.008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Spine &#40;Phila Pa 1976&#41;"
                        "fecha" => "2014"
                        "volumen" => "15"
                        "paginaInicial" => "783"
                        "paginaFinal" => "784"
                        "itemHostRev" => array:3 [
                          "pii" => "S0959804911007891"
                          "estado" => "S300"
                          "issn" => "09598049"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An atypical infectious complication of anterior cervical surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "P&#46; Violon"
                            1 => "Z&#46; Patay"
                            2 => "J&#46; Braeckeveldt"
                            3 => "B&#46; Pirotte"
                            4 => "A&#46; Kentos"
                            5 => "J&#46; Brotchi"
                            6 => "D&#46; Bal&#233;riaux"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s002340050409"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neuroradiology"
                        "fecha" => "1997"
                        "volumen" => "39"
                        "paginaInicial" => "278"
                        "paginaFinal" => "281"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9144677"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Structure&#44; function and diversity of the healthy human microbiome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "Human Microbiome Project Consortium"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/nature11234"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nature"
                        "fecha" => "2012"
                        "volumen" => "486"
                        "paginaInicial" => "207"
                        "paginaFinal" => "214"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22699609"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "<span class="elsevierStyleItalic">Propionibacterium acnes</span>&#58; from commensal to opportunistic biofilm-associated implant pathogen"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Y&#46; Achermann"
                            1 => "E&#46;J&#46;C&#46; Goldstein"
                            2 => "T&#46; Coenye"
                            3 => "M&#46;E&#46; Shirtliff"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/CMR. 00092-13"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Microbiol Rev"
                        "fecha" => "2014"
                        "volumen" => "27"
                        "paginaInicial" => "419"
                        "paginaFinal" => "440"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24982315"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic relevance of beta2-transferrin for the detection of cerebrospinal fluid fistulas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Warnecke"
                            1 => "T&#46; Averbeck"
                            2 => "U&#46; Wurster"
                            3 => "M&#46; Harmening"
                            4 => "T&#46; Lenarz"
                            5 => "T&#46; St&#246;ver"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archotol.130.10.1178"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Otolaryngol Head Neck Surg"
                        "fecha" => "2004"
                        "volumen" => "130"
                        "paginaInicial" => "1178"
                        "paginaFinal" => "1184"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15492165"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Neuraminidase production by <span class="elsevierStyleItalic">Propionibacterium acnes</span>-strains isolated from patients with acne vulgaris&#44; seborrheic eczema and healthy subjects"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "U&#46; H&#246;ffler"
                            1 => "M&#46; Gloor"
                            2 => "H&#46; von Nicolai"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Zentralblatt fur Bakteriol Mikrobiol und Hyg Int J Microbiol Hyg"
                        "fecha" => "1981"
                        "volumen" => "250"
                        "paginaInicial" => "122"
                        "paginaFinal" => "126"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Is spinal instrumentation a risk factor for late-onset infection in cases of distant infection or surgery&#63; Case report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46; Naderi"
                            1 => "F&#46; Acar"
                            2 => "T&#46; Mertol"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Neurosurg Focus"
                        "fecha" => "2003"
                        "volumen" => "15"
                        "paginaInicial" => "E15"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15350046"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack394298"
        "titulo" => "Acknowledgements"
        "texto" => "<p id="par0100" class="elsevierStylePara elsevierViewall">We would like to thank Carmen Cabellos&#44; MD&#44; PhD&#44; not only for her help with the conception of this work&#44; but also for her everyday dedication&#46;</p>"
        "vista" => "all"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/11301473/0000003000000002/v1_201902260607/S113014731830023X/v1_201902260607/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "392"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Casos Cl&#237;nicos"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/11301473/0000003000000002/v1_201902260607/S113014731830023X/v1_201902260607/en/main.pdf?idApp=UINPBA00004B&text.app=https://revistaneurocirugia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S113014731830023X?idApp=UINPBA00004B"
]
Compartir
Información de la revista

Estadísticas

Siga este enlace para acceder al texto completo del artículo

Case Report
Delayed surgical site infection 2 years after cervical disk arthroplasty. Case report and literature review
Infección diferida del sitio quirúrgico 2 años después de la artroplastia de disco cervical. Caso clínico y revisión de la literatura
Aleix Rossellóa,
Autor para correspondencia
, Jose Luis Sanmillána, Luis López-Obarrioa, Iván Pelegrínb, Andreu Gabarrósa, Oscar Godinoa
a Neurosurgery Department, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
b Infectious Diseases Department, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
Leído
77
Veces
se ha leído el artículo
7
Total PDF
70
Total HTML
Compartir estadísticas
 array:23 [
  "pii" => "S113014731830023X"
  "issn" => "11301473"
  "doi" => "10.1016/j.neucir.2018.02.004"
  "estado" => "S300"
  "fechaPublicacion" => "2019-03-01"
  "aid" => "322"
  "copyright" => "Sociedad Espa&#241;ola de Neurocirug&#237;a"
  "copyrightAnyo" => "2018"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "crp"
  "cita" => "Neurocirugia. 2019;30:81-6"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 12
    "formatos" => array:2 [
      "HTML" => 8
      "PDF" => 4
    ]
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S1130147318300241"
    "issn" => "11301473"
    "doi" => "10.1016/j.neucir.2018.02.005"
    "estado" => "S300"
    "fechaPublicacion" => "2019-03-01"
    "aid" => "323"
    "copyright" => "Sociedad Espa&#241;ola de Neurocirug&#237;a"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Neurocirugia. 2019;30:87-93"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 19
      "formatos" => array:2 [
        "HTML" => 12
        "PDF" => 7
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>"
      "titulo" => "Symptomatic delayed coil migration after balloon assisted embolization&#58; An underreported adverse event&#63;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "87"
          "paginaFinal" => "93"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Migraci&#243;n Sintom&#225;tica Tard&#237;a de Coil tras Embolizaci&#243;n Asistida con Bal&#243;n&#58; &#191;un evento adverso infra descrito&#63;"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0020"
          "etiqueta" => "Fig&#46; 4"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr4.jpeg"
              "Alto" => 602
              "Ancho" => 1298
              "Tamanyo" => 65079
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Cerebral angiography&#44; internal carotid artery injection&#44; oblique projection demonstrated migration of 2 coil loops&#44; one to calloso-marginal branch and the other to pericallosal branch of the right anterior cerebral artery&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Lino Fonseca, Rafael Najarro-Quispe, Ana Rodr&#237;guez-Hern&#225;ndez, Ramon Torn&#233;, Dario G&#225;ndara-Sabatini, Fuat Arikan, Pilar Ba&#241;os-Carrasco"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "Lino"
              "apellidos" => "Fonseca"
            ]
            1 => array:2 [
              "nombre" => "Rafael"
              "apellidos" => "Najarro-Quispe"
            ]
            2 => array:2 [
              "nombre" => "Ana"
              "apellidos" => "Rodr&#237;guez-Hern&#225;ndez"
            ]
            3 => array:2 [
              "nombre" => "Ramon"
              "apellidos" => "Torn&#233;"
            ]
            4 => array:2 [
              "nombre" => "Dario"
              "apellidos" => "G&#225;ndara-Sabatini"
            ]
            5 => array:2 [
              "nombre" => "Fuat"
              "apellidos" => "Arikan"
            ]
            6 => array:2 [
              "nombre" => "Pilar"
              "apellidos" => "Ba&#241;os-Carrasco"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147318300241?idApp=UINPBA00004B"
    "url" => "/11301473/0000003000000002/v1_201902260607/S1130147318300241/v1_201902260607/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S113014731830109X"
    "issn" => "11301473"
    "doi" => "10.1016/j.neucir.2018.11.003"
    "estado" => "S300"
    "fechaPublicacion" => "2019-03-01"
    "aid" => "357"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Neurocirugia. 2019;30:77-80"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 115
      "formatos" => array:2 [
        "HTML" => 95
        "PDF" => 20
      ]
    ]
    "es" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Art&#237;culo especial</span>"
      "titulo" => "Llamada para participar en el estudio internacional de resultados del traumatismo craneoencef&#225;lico <span class="elsevierStyleItalic">&#40;Global Neurotrauma Outcomes Study&#41;</span>"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "77"
          "paginaFinal" => "80"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Call to participate in the international study of traumatic brain injury results &#40;Global Neurotrauma Outcomes Study&#41;"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Irene Panero P&#233;rez, Ana-Mar&#237;a Casta&#241;o Le&#243;n, Mar&#237;a Luisa Gand&#237;a Gonz&#225;lez, Angelos Kolias"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Irene"
              "apellidos" => "Panero P&#233;rez"
            ]
            1 => array:2 [
              "nombre" => "Ana-Mar&#237;a"
              "apellidos" => "Casta&#241;o Le&#243;n"
            ]
            2 => array:2 [
              "nombre" => "Mar&#237;a Luisa"
              "apellidos" => "Gand&#237;a Gonz&#225;lez"
            ]
            3 => array:2 [
              "nombre" => "Angelos"
              "apellidos" => "Kolias"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2529849619300036"
        "doi" => "10.1016/j.neucie.2018.11.003"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529849619300036?idApp=UINPBA00004B"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S113014731830109X?idApp=UINPBA00004B"
    "url" => "/11301473/0000003000000002/v1_201902260607/S113014731830109X/v1_201902260607/es/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>"
    "titulo" => "Delayed surgical site infection 2 years after cervical disk arthroplasty&#46; Case report and literature review"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "81"
        "paginaFinal" => "86"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Aleix Rossell&#243;, Jose Luis Sanmill&#225;n, Luis L&#243;pez-Obarrio, Iv&#225;n Pelegr&#237;n, Andreu Gabarr&#243;s, Oscar Godino"
        "autores" => array:6 [
          0 => array:4 [
            "nombre" => "Aleix"
            "apellidos" => "Rossell&#243;"
            "email" => array:1 [
              0 => "a&#46;rossello&#64;bellvitgehospital&#46;cat"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Jose Luis"
            "apellidos" => "Sanmill&#225;n"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Luis"
            "apellidos" => "L&#243;pez-Obarrio"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Iv&#225;n"
            "apellidos" => "Pelegr&#237;n"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Andreu"
            "apellidos" => "Gabarr&#243;s"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Oscar"
            "apellidos" => "Godino"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Neurosurgery Department&#44; Hospital Universitari de Bellvitge&#44; L&#8217;Hospitalet de Llobregat&#44; Barcelona&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Infectious Diseases Department&#44; Hospital Universitari de Bellvitge&#44; L&#8217;Hospitalet de Llobregat&#44; Barcelona&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Infecci&#243;n diferida del sitio quir&#250;rgico 2 a&#241;os despu&#233;s de la artroplastia de disco cervical&#46; Caso cl&#237;nico y revisi&#243;n de la literatura"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1232
            "Ancho" => 950
            "Tamanyo" => 112810
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Barium swallow&#46; Barium swallow&#44; showing left displacement and constriction of the esophagus&#44; with no pass of contrast into the cavity&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Anterior cervical discectomy and fusion &#40;or disk arthroplasty&#41; has a low complication rate&#44; with a reported infection rate lower than 3&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1&#44;2</span></a> Most surgical site infections &#40;SSI&#41; occur in the early postoperative period&#46; Delayed SSI&#44; defined as occurring after 3 months from surgery&#44; is a very rare complication&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> We report a case of delayed prevertebral cervical abscess diagnosed 2 years after two-level cervical arthroplasty&#44; discuss the diagnosis and etiology&#44; and review the literature&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 55 years-old male consulted for a right cervical mass that had been slowly growing for eight weeks&#46; Past medical history included high blood pressure&#44; hyperlipidemia&#44; smoking and alcoholic hepatopathy&#46; Two years before&#44; the patient was treated of disk herniation in another center&#44; with C4&#8211;C5&#8211;C6 discectomy and arthroplasty &#40;M6-C&#44; Spinal Kinetics&#44; Sunnyvale&#44; CA&#44; USA&#41;&#44; with an uneventful postoperative period&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Physical examination revealed a fluctuant and tight right laterocervical mass&#44; without fever&#44; dysphagia&#44; dyspnea or neurological deficits&#46; Estimated sedimentation rate &#40;ESR&#41; was 20<span class="elsevierStyleHsp" style=""></span>mm&#47;h&#44; C-reactive protein was &#40;CRP&#41; &#60;1<span class="elsevierStyleHsp" style=""></span>mg&#47;dL and white blood cell &#40;WBC&#41; count was 6500&#47;mm<span class="elsevierStyleSup">3</span> with 60&#37; of neutrophils&#46; Human immunodeficiency virus test was negative&#46; Flexible laryngeal and esophageal endoscopy revealed an extrinsic laryngeal constriction but no intraluminal pathology&#46; CT scan showed a right cervical prevertebral hypodens mass with mild peripheral iodine contrast enhancement at C4&#8211;D2 level &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; MR revealed a T1WI hypointense and T2WI and STIR hyperintense mass &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The barium swallow did not show pass of contrast into the cavity &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Our primary diagnosis was delayed SSI because of the patient&#39;s risk factors&#46; However&#44; due to the slow growing of the collection&#44; we could not exclude tuberculosis or post-surgical pseudomeningocele because of the lack of systemic inflammatory reaction and MR findings&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Finally&#44; owing to slow but continuous mass enlargement&#44; an ultrasound guided puncture was performed&#44; obtaining pus&#44; but it did not provide enough evacuation neither microbiological diagnosis&#46; Consequently&#44; we indicated surgical exploration&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Intraoperatively&#44; we found a capsulated cavity containing pus that extended to the prevertebral space in contact with the prostheses&#44; without any associated tracheal or esophageal lesion&#46; After abscess debridement&#44; prostheses were removed and substituted for iliac crest bone graft &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#44; and rifampicin was instilated&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">We actively looked for a cerebrospinal fluid leak&#44; aided by Valsalva maneuver&#44; but we could not demonstrate it&#46; In order to rule out a pseudomeningocele&#44; we performed beta-2-transferrine test&#46; It yielded a positive result but&#44; as later discussed&#44; we assumed it as a false positive&#46; The bacterial culture and polymerase chain reaction analysis &#40;PCR&#41; were positive for <span class="elsevierStyleItalic">Propionibacterium acnes</span>&#44; so antibiotic was adjusted from vancomycin and meropenem to amoxicillin-clavulanate 1<span class="elsevierStyleHsp" style=""></span>g every 8<span class="elsevierStyleHsp" style=""></span>h for 6 weeks&#46; The postoperative period was uneventful&#46; At 6 months follow-up&#44; the patient remained asymptomatic&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">Anterior cervical discectomy is a common procedure with a low infection rate&#44; being most of them during the early postoperative period&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1&#44;2</span></a> In our literature review we found 7 cases of delayed SSI&#44; defined as infection occurring after 3 months from surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Bhise<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a> reported a patient with fever and pus-discharging sinus over the posterior triangle of the neck&#44; without any cavitation around the fused segment&#44; and suggested a low-grade infection at implant site as the probable etiology&#46; Christiano<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a> reported a case that presented with dysphagia and fever secondary to a prevertebral abscess&#44; and stated the cause of infection was elusive&#46; Hur<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a> presented a case of neck pain and progressive spinal cord syndrome due to an epidural abscess and proposed micro injury of esophagus due to implants as a causal factor&#46; Jin<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> reported a patient who consulted for blood-tinged sputum and a laryngeal mass&#44; CT and MR revealed a prevertebral abscess associated to osteomyelitis&#44; and they reported the cause of infection as elusive&#46; Kuriloff<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> published a case of a patient who consulted for dysphagia&#44; cervical inflammation and fever&#44; whose CT revealed a prevertebral abscess&#44; and that was secondary to an esophageal fistula&#46; Tsitsopoulos<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a> presented a patient with dysphagia and pus draining from incision due to a fistula from prevertebral space&#44; and suggested it may have originated from the newly formed bone at the fusion site&#46; Violon<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a> reported a case of neck pain and dysphagia due to prevertebral abscess and stated an insidious esophageal wall perforation might be evoked as the possible source of the infection&#46; All cases had a good outcome after surgical revision and antibiotherapy&#44; except the patient reported by Hur&#44;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a> who died due to sepsis&#46; See <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> for a detailed review of these reported cases&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">In these reported cases&#44; the predominant microbiological isolation was <span class="elsevierStyleItalic">Streptococcus</span> spp&#46;&#44; associated to 1 case of <span class="elsevierStyleItalic">Veilonella</span> spp&#46; and 2 of <span class="elsevierStyleItalic">Peptostreptococcus</span> spp&#46;&#44; which are members of the salivary and gut microbiome&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">We could not find a common pattern between clinical manifestation&#44; blood test results&#44; type of implant and associated osteomyelitis in these patients with delayed SSI&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Different causes of delayed SSI are proposed among reported cases&#58; low grade infection at implant site&#44; microinjury of esophagus&#44; definite esophageal fistula&#44; fistulation to skin from the newly formed bone at fusion site&#44; but infection was also reported as elusive in 2 cases&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Regarding treatment options&#44; in all cases except in Tsitsopoulos&#8217;&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a> surgical debridement and removal of implants was performed&#44; followed by antibiotic adjusted by microorganism culture&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">To our knowledge&#44; this is the only report of a delayed cervical spine SSI manifesting as a slowly growing cervical mass as the only clinical manifestation without any associated inflammatory findings&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The microbiological isolation of <span class="elsevierStyleItalic">P&#46; acnes</span>&#44; confirmed by PCR assay&#44; implies some discussion&#46; First&#44; it is a member of skin and gut floras&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a> which could favor the hypotheses of either latent implant contamination or acquired and spontaneously healed esophageal microperforation&#46; Second&#44; it is known as a microfilm creator&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> which could support the latent implant contamination hypothesis&#44; and favors surgical removal of implants&#46; Third&#44; the patient underwent arthroplasty instead of fusion&#44; which raises the question if the different implant properties could be a risk factor for a delayed implant-related SSI by biofilm-producing bacteria&#46; Finally&#44; it has a slow growth&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> which would justify this unusual course for a cervical abscess&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The beta-2-transferrin test is an elementary tool in the diagnosis of cerebrospinal fluid leak&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> MR findings raised the possibility of a spontaneously closed and subsequently infected pseudomeningocele&#46; Therefore&#44; we performed beta-2-transferrin test in the sample of purulent material&#46; We obtained a positive result&#44; which lead to strict control of meningeal irritation signs or cerebrospinal fluid fistula&#46; Nevertheless&#44; the lack of meningeal symptomatology&#44; the non-confirming imaging tests&#44; the intraoperative findings and the neuraminidase secretion of most of <span class="elsevierStyleItalic">P&#46; acnes</span> strains&#44;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a> a known cause of false-positive test due to transferrine enzymatic processing&#44;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> lead us to assume it as a false positive&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Acquired esophageal&#47;tracheal microperforation&#44; latent clinically-silent implant infection and bacteremia<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> have been described as possible causes of delayed SSI in the cervical spine&#46; In this case&#44; micro-trauma related and spontaneously healed esophageal micro-perforation could not be completely ruled out&#46; Nonetheless&#44; due to <span class="elsevierStyleItalic">P&#46; acnes</span> slow growth and microfilm formation&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> a latent implant infection was the infection cause we assumed&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusion</span><p id="par0085" class="elsevierStylePara elsevierViewall">We report an illustrative case of a delayed cervical paravertebral abscess following uneventful cervical disk arthroplasty&#46; Our patient presented with a slowly growing paravertebral abscess appearing 2 years after cervical surgery without any inflammatory parameters&#46; Delayed SSI is a rare but potentially severe complication after anterior cervical discectomy&#46; Revision surgery is almost always required followed by long-course antibiotic treatment&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflicts of interest and source of funding</span><p id="par0090" class="elsevierStylePara elsevierViewall">The manuscript submitted does not contain information about medical device&#40;s&#41;&#47;drug&#40;s&#41;&#46; No funds were received in support of this work&#46; No benefits in any form have been or will be received related directly or indirectly to the subject of this manuscript&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The present research has not received any specific scholarship from public&#44; commercial&#44; or non-profit agencies&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:12 [
        0 => array:3 [
          "identificador" => "xres1155375"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1082929"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "xpalclavsec1082931"
          "titulo" => "Abbreviations"
        ]
        3 => array:3 [
          "identificador" => "xres1155374"
          "titulo" => "Resumen"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        4 => array:2 [
          "identificador" => "xpalclavsec1082930"
          "titulo" => "Palabras clave"
        ]
        5 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        6 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Case report"
        ]
        7 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Conclusion"
        ]
        9 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Conflicts of interest and source of funding"
        ]
        10 => array:2 [
          "identificador" => "xack394298"
          "titulo" => "Acknowledgements"
        ]
        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-10-26"
    "fechaAceptado" => "2018-02-15"
    "PalabrasClave" => array:2 [
      "en" => array:2 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1082929"
          "palabras" => array:6 [
            0 => "Cervical disk arthroplasty"
            1 => "Delayed infection"
            2 => "Surgical site infection"
            3 => "Cervical abscess"
            4 => "Beta-2-transferrin"
            5 => "Neuraminidase"
          ]
        ]
        1 => array:4 [
          "clase" => "abr"
          "titulo" => "Abbreviations"
          "identificador" => "xpalclavsec1082931"
          "palabras" => array:9 [
            0 => "BOP"
            1 => "CRP"
            2 => "CSF"
            3 => "CT"
            4 => "ESR"
            5 => "MR"
            6 => "PCR"
            7 => "SSI"
            8 => "WBC"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1082930"
          "palabras" => array:6 [
            0 => "Artroplastia cervical"
            1 => "Infecci&#243;n diferida"
            2 => "Infecci&#243;n del sitio quir&#250;rgico"
            3 => "Absceso cervical"
            4 => "Beta-2-transferrina"
            5 => "Neuraminidasa"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Anterior cervical discectomy has a low non-mechanical complication rate&#46; In our literature review&#44; we found 7 cases of delayed surgical site infection&#46; We report a case of cervical prevertebral abscess due to <span class="elsevierStyleItalic">Propionibacterium acnes</span> 2 years after discectomy and arthroplasty&#44; with a beta-2-transferrin false positive test as a complementary highlighted finding&#46; We discuss the diagnosis and etiology of this rare delayed infectious complication&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La discectom&#237;a cervical anterior tiene una baja tasa de complicaciones no mec&#225;nicas&#46; En la revisi&#243;n de la literatura&#44; encontramos 7 casos de infecci&#243;n diferida del sitio quir&#250;rgico&#46; Presentamos un caso de absceso cervical prevertebral secundario a <span class="elsevierStyleItalic">Propionibacterium acnes</span> 2 a&#241;os despu&#233;s de la cirug&#237;a&#44; asociado a un falso positivo del test de beta-2-transferrina como hallazgo complementario a destacar&#44; y discutimos el diagn&#243;stico y la etiolog&#237;a de esta rara complicaci&#243;n infecciosa diferida&#46;</p></span>"
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1625
            "Ancho" => 1200
            "Tamanyo" => 140217
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">CT and MR&#46; &#40;A&#41; Iodine contrast-enhanced CT scan&#44; showing a right cervical prevertebral hypodense mass with mild peripheral contrast enhancement&#46; &#40;B&#41; Sagittal cervical spine MR&#44; showing a T1 hypointense mass&#46; &#40;C&#41; Sagital cervical spine MR&#44; showing a T2 hyperintense mass&#44; suggestive of either cerebrospinal fluid collection or abscess&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1232
            "Ancho" => 950
            "Tamanyo" => 112810
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Barium swallow&#46; Barium swallow&#44; showing left displacement and constriction of the esophagus&#44; with no pass of contrast into the cavity&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Fig&#46; 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 517
            "Ancho" => 1800
            "Tamanyo" => 110118
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Pre- and intraoperative pictures of the abscess&#46; &#40;A&#41; Lateral view&#46; &#40;B&#41; Anterior view&#46; &#40;C&#41; Aspiration of abscess content&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reference&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Age&#44; gender&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Time from surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Past medical history&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Presentation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Blood test&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Imaging diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Type of implant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Surgical treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Microbiology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Osteomyelitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Antibiotic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Etiological diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Outcome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bhise<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30 y&#44; male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Unremarkable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pus discharging from sinus over the posterior triangle of neck and fever&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">High ESR and CRP&#46; HIV negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CT&#58; single screw fixation with evidence of fusion without vertebral destruction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fibular bone graft and buttress screw fixation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Screw removal&#44; debridement and saline washing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Beta-hemolytic <span class="elsevierStyleItalic">Streptococci</span> sensitive to linezolid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cefuroxime and amikacin for 5 days&#44; followed by Linezolid for 5 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Low-grade infection at implant site&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Christiano<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52 y&#44; female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Unremarkable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dysphagia and fever&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">WBC 11&#46;7&#44; ESR 32&#44; and CRP 91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CT&#58; abscess anterior to the fusion plate<br>Barium-swallow study&#58; normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Unicortical c allograft and plate-screw&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Instrumentation removal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Streptococcus intermedius</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Clindamycin for 6 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Elusive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hur<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68 y&#44; male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14<span class="elsevierStyleHsp" style=""></span>m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Unremarkable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Progressive paraparesis&#44; urinary retention and posterior neck pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">High ESR&#44; CRP and WBC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">X-ray and CT&#58; graft extrusion&#44; screw loosening&#44; gas collection<br>MRI&#58; spinal epidural abscess&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Allograft and plate-screw construction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Instrumentation removal&#44; corpectomy&#44; debridement and saline washing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Streptococcus anginosus</span><br>MRSA&#44; and <span class="elsevierStyleItalic">K&#46; pneumoniae</span> in 2nd surgical samples&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Vancomycin immediately after surgery&#44; Ceftriaxone<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>Metronidazole after <span class="elsevierStyleItalic">S&#46; anginosus</span> isolation&#44; Vancomycin and Meropenem after MRSA and <span class="elsevierStyleItalic">K&#46; pneumonia</span> isolation&#44; and Linezolid after meningitis was diagnosed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Micro injury of esophagus due to implants&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Death due to sepsis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Jin<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">74 y&#44; male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Unremarkable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bloody sputum and laryngeal mass&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Normal ESR&#44; CRP and WBC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">X-ray&#58; destruction of C4 and C5 bodies&#46;<br><br>CT and MRI&#58; enhancing and destructive lesion at C4&#8211;5 disk space with anterior protrusion to the prevertebral and retropharyngeal spaces&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Biocompatible osteoconductive polymer &#40;BOP&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Abscess debridement&#44; C4 corpectomy and ACDF at C3&#8211;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Flomoxef&#44; Netilmicin&#44; Metronidazole for 11 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Elusive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kuriloff<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38 y&#44; female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4<span class="elsevierStyleHsp" style=""></span>m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rheumatoid spondylitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dysphagia&#44; cervical inflammation and fever&#44; appearing 4 months after C7-T1 osteotomies and halo to correct flexion deformity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">WBC 12&#44;400&#47;mm<span class="elsevierStyleSup">3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CT&#58; large prevertebral abscess&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Plate and screw fixation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Abscess debridement&#44; instrumentation removal and esophageal reparation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Peptococcus</span> and <span class="elsevierStyleItalic">P&#46; aeruginosa</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Piperacillin and tobramycin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Esophageal fistula&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tsitsopoulos<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60 y&#44; female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dysphagia and pus draining from incision&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MRI&#58; fistula from anterior part of C6 body to the skin<br>Esophagoscopy and barium swallow&#58; normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Iliac crest bone&#44; cage&#44; and plate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fistula excision&#46; No removal of implants&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fistula may have originated from the newly formed bone at the fusion site&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Violon<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44 y&#44; female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Neck pain and dysphagia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Normal ESR&#44; CRP and WBC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CT&#58; thickening of the prevertebral tissues<br>MRI&#58; signal abnormalities in the two adjacent vertebral bodies&#44; and marked and homogeneous enhancement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Synthetic biocopolymer &#40;BOP&#41; graft&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Granulomatous tissue and BOP graft resection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">S&#46; anginosus&#44; S&#46; intermedius&#44; Veilonella parvula</span> and <span class="elsevierStyleItalic">Peptostreptococcus anaerobius</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Clindamycin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Spontaneously closed&#44; clinically latent&#44; insidious oesophageal perforation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1972390.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Overview of 7 reported cases of anterior cervical spine delayed SSI&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:15 [
            0 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Perioperative and delayed complications associated with the surgical treatment of cervical spondylotic myelopathy based on 302 patients from the AOSpine North America Cervical Spondylotic Myelopathy Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46;G&#46; Fehlings"
                            1 => "J&#46;S&#46; Smith"
                            2 => "B&#46; Kopjar"
                            3 => "P&#46;M&#46; Arnold"
                            4 => "S&#46;T&#46; Yoon"
                            5 => "A&#46;R&#46; Vaccaro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3171/2012.1.SPINE11467"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Neurosurg Spine"
                        "fecha" => "2012"
                        "volumen" => "16"
                        "paginaInicial" => "425"
                        "paginaFinal" => "432"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22324802"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Anterior cervical discectomy and fusion associated complications"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "K&#46;N&#46; Fountas"
                            1 => "E&#46;Z&#46; Kapsalaki"
                            2 => "L&#46;G&#46; Nikolakakos"
                            3 => "H&#46;F&#46; Smisson"
                            4 => "K&#46;W&#46; Johnston"
                            5 => "A&#46;A&#46; Grigorian"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/BRS.0b013e318154c57e"
                      "Revista" => array:5 [
                        "tituloSerie" => "Spine &#40;Phila Pa 1976&#41;"
                        "fecha" => "2007"
                        "volumen" => "32"
                        "paginaInicial" => "2310"
                        "paginaFinal" => "2317"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Infection with spinal instrumentation&#58; review of pathogenesis&#44; diagnosis&#44; prevention&#44; and management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;K&#46; Kasliwal"
                            1 => "L&#46;A&#46; Tan"
                            2 => "V&#46;C&#46; Traynelis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/2152-7806.120783"
                      "Revista" => array:7 [
                        "tituloSerie" => "Surg Neurol Int"
                        "fecha" => "2013"
                        "volumen" => "4"
                        "numero" => "Suppl 5"
                        "paginaInicial" => "S392"
                        "paginaFinal" => "S403"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24340238"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Late prevertebral abscess with sinus following anterior cervical corpectomy and fusion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46; Bhise"
                            1 => "A&#46; Mathesul"
                            2 => "P&#46; Deokate"
                            3 => "A&#46; Chandanwale"
                            4 => "G&#46; Bartakke"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/1793-5482.161172"
                      "Revista" => array:5 [
                        "tituloSerie" => "Asian J Neurosurg"
                        "fecha" => "2015"
                        "volumen" => "10"
                        "paginaInicial" => "272"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26425154"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Late prevertebral abscess after anterior cervical fusion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46;D&#46; Christiano"
                            1 => "I&#46;M&#46; Goldstein"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/BRS.0b013e3181fc9b09"
                      "Revista" => array:5 [
                        "tituloSerie" => "Spine &#40;Phila Pa 1976&#41;"
                        "fecha" => "2011"
                        "volumen" => "36"
                        "paginaInicial" => "E798"
                        "paginaFinal" => "E802"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Unusual fatal infections after anterior cervical spine surgeries"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;W&#46; Hur"
                            1 => "J&#46;B&#46; Lee"
                            2 => "J&#46;H&#46; Kim"
                            3 => "S&#46;H&#46; Kim"
                            4 => "T&#46;H&#46; Cho"
                            5 => "J&#46;N&#46; Suh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.14245/kjs.2012.9.3.304"
                      "Revista" => array:6 [
                        "tituloSerie" => "Korean J Spine"
                        "fecha" => "2012"
                        "volumen" => "9"
                        "paginaInicial" => "304"
                        "paginaFinal" => "308"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25983839"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Late infection from anterior cervical discectomy and fusion after twenty years"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46;-W&#46; Jin"
                            1 => "S&#46;-H&#46; Kim"
                            2 => "J&#46;-I&#46; Choi"
                            3 => "S&#46;-K&#46; Ha"
                            4 => "D&#46;-J&#46; Lim"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.14245/kjs.2014.11.1.22"
                      "Revista" => array:6 [
                        "tituloSerie" => "Korean J Spine"
                        "fecha" => "2014"
                        "volumen" => "11"
                        "paginaInicial" => "22"
                        "paginaFinal" => "24"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24891869"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Delayed neck infection following anterior spine surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46;B&#46; Kuriloff"
                            1 => "S&#46; Blaugrund"
                            2 => "J&#46; Ryan"
                            3 => "P&#46; O&#8217;Leary"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Laryngoscope"
                        "fecha" => "1987"
                        "volumen" => "97"
                        "paginaInicial" => "1094"
                        "paginaFinal" => "1098"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3626736"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A delayed spinocutaneous fistula after anterior cervical discectomy and fusion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46;P&#46; Tsitsopoulos"
                            1 => "N&#46; Marklund"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.spinee.2014.11.008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Spine &#40;Phila Pa 1976&#41;"
                        "fecha" => "2014"
                        "volumen" => "15"
                        "paginaInicial" => "783"
                        "paginaFinal" => "784"
                        "itemHostRev" => array:3 [
                          "pii" => "S0959804911007891"
                          "estado" => "S300"
                          "issn" => "09598049"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An atypical infectious complication of anterior cervical surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "P&#46; Violon"
                            1 => "Z&#46; Patay"
                            2 => "J&#46; Braeckeveldt"
                            3 => "B&#46; Pirotte"
                            4 => "A&#46; Kentos"
                            5 => "J&#46; Brotchi"
                            6 => "D&#46; Bal&#233;riaux"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s002340050409"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neuroradiology"
                        "fecha" => "1997"
                        "volumen" => "39"
                        "paginaInicial" => "278"
                        "paginaFinal" => "281"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9144677"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Structure&#44; function and diversity of the healthy human microbiome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "Human Microbiome Project Consortium"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/nature11234"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nature"
                        "fecha" => "2012"
                        "volumen" => "486"
                        "paginaInicial" => "207"
                        "paginaFinal" => "214"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22699609"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "<span class="elsevierStyleItalic">Propionibacterium acnes</span>&#58; from commensal to opportunistic biofilm-associated implant pathogen"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Y&#46; Achermann"
                            1 => "E&#46;J&#46;C&#46; Goldstein"
                            2 => "T&#46; Coenye"
                            3 => "M&#46;E&#46; Shirtliff"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/CMR. 00092-13"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Microbiol Rev"
                        "fecha" => "2014"
                        "volumen" => "27"
                        "paginaInicial" => "419"
                        "paginaFinal" => "440"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24982315"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic relevance of beta2-transferrin for the detection of cerebrospinal fluid fistulas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Warnecke"
                            1 => "T&#46; Averbeck"
                            2 => "U&#46; Wurster"
                            3 => "M&#46; Harmening"
                            4 => "T&#46; Lenarz"
                            5 => "T&#46; St&#246;ver"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archotol.130.10.1178"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Otolaryngol Head Neck Surg"
                        "fecha" => "2004"
                        "volumen" => "130"
                        "paginaInicial" => "1178"
                        "paginaFinal" => "1184"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15492165"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Neuraminidase production by <span class="elsevierStyleItalic">Propionibacterium acnes</span>-strains isolated from patients with acne vulgaris&#44; seborrheic eczema and healthy subjects"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "U&#46; H&#246;ffler"
                            1 => "M&#46; Gloor"
                            2 => "H&#46; von Nicolai"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Zentralblatt fur Bakteriol Mikrobiol und Hyg Int J Microbiol Hyg"
                        "fecha" => "1981"
                        "volumen" => "250"
                        "paginaInicial" => "122"
                        "paginaFinal" => "126"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Is spinal instrumentation a risk factor for late-onset infection in cases of distant infection or surgery&#63; Case report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46; Naderi"
                            1 => "F&#46; Acar"
                            2 => "T&#46; Mertol"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Neurosurg Focus"
                        "fecha" => "2003"
                        "volumen" => "15"
                        "paginaInicial" => "E15"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15350046"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack394298"
        "titulo" => "Acknowledgements"
        "texto" => "<p id="par0100" class="elsevierStylePara elsevierViewall">We would like to thank Carmen Cabellos&#44; MD&#44; PhD&#44; not only for her help with the conception of this work&#44; but also for her everyday dedication&#46;</p>"
        "vista" => "all"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/11301473/0000003000000002/v1_201902260607/S113014731830023X/v1_201902260607/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "392"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Casos Cl&#237;nicos"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/11301473/0000003000000002/v1_201902260607/S113014731830023X/v1_201902260607/en/main.pdf?idApp=UINPBA00004B&text.app=https://revistaneurocirugia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S113014731830023X?idApp=UINPBA00004B"
]
Información del artículo
ISSN: 11301473
Idioma original: Inglés
Datos actualizados diariamente
año/Mes Html Pdf Total
2024 Noviembre 1 0 1
2024 Octubre 3 0 3
2024 Septiembre 13 2 15
2024 Agosto 3 0 3
2024 Julio 3 0 3
2024 Junio 1 0 1
2024 Mayo 2 0 2
2024 Abril 1 0 1
2024 Marzo 1 0 1
2024 Enero 3 0 3
2023 Diciembre 2 0 2
2023 Noviembre 4 0 4
2023 Octubre 2 0 2
2023 Agosto 4 0 4
2023 Julio 2 0 2
2023 Junio 5 0 5
2023 Abril 1 0 1
2023 Marzo 5 1 6
2023 Febrero 1 0 1
2023 Enero 1 0 1
2022 Octubre 1 0 1
2022 Agosto 1 0 1
2022 Julio 1 0 1
2022 Mayo 1 0 1
2019 Septiembre 4 0 4
2019 Junio 2 2 4
2019 Mayo 1 0 1
2019 Marzo 1 2 3
Mostrar todo

Siga este enlace para acceder al texto completo del artículo

Idiomas
Neurocirugía
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?