array:22 [
  "pii" => "S1130147324000897"
  "issn" => "11301473"
  "doi" => "10.1016/j.neucir.2024.08.001"
  "estado" => "S300"
  "fechaPublicacion" => "2024-11-01"
  "aid" => "624"
  "copyright" => "The Author(s)"
  "copyrightAnyo" => "2024"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "crp"
  "cita" => "Neurocirugia. 2024;35:334-9"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1130147324000769"
    "issn" => "11301473"
    "doi" => "10.1016/j.neucir.2024.07.003"
    "estado" => "S300"
    "fechaPublicacion" => "2024-11-01"
    "aid" => "619"
    "copyright" => "Sociedad Española de Neurocirugía"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Neurocirugia. 2024;35:329-33"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "es" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Caso cl&#237;nico</span>"
      "titulo" => "Papel de la craniectom&#237;a descompresiva en el edema cerebral fulminante agudo"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "329"
          "paginaFinal" => "333"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Decompressive craniectomy in the acute fulminant cerebral edema"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figura 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 693
              "Ancho" => 1801
              "Tamanyo" => 127779
            ]
          ]
          "descripcion" => array:1 [
            "es" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Im&#225;genes de resonancia en T2&#46; Tumefacci&#243;n del par&#233;nquima frontotemporal&#46; A&#41; Axial a las 72 horas&#46; B&#41; Coronal a las 72 horas&#46; Cambios secundarios a craniectom&#237;a bifrontal&#46; En ambos cortes se observa una importante y extensa tumefacci&#243;n&#44; con hiperse&#241;al en secuencias potenciadas en T2&#46; Afecta a los n&#250;cleos caudados y put&#225;menes respetando t&#225;lamo&#44; corteza occipitoparietal y cerebelo&#46; Los hallazgos son compatibles con encefalitis&#44; sin un patr&#243;n que sugiera una etiolog&#237;a concreta&#46; C&#41; Corte axial al nivel de la imagen en A&#44; tras la cirug&#237;a de craneoplastia a los 21 d&#237;as tras la cirug&#237;a descompresiva&#46; Aumento difuso de la se&#241;al en T2 y en localizaci&#243;n cortical&#44; subcortical y en menor medida en la sustancia blanca de los l&#243;bulos frontales y parietales y parcheado en los l&#243;bulos occipitales y temporales&#46; En los l&#243;bulos frontales se observan signos de p&#233;rdida de volumen&#46; L&#237;nea media centrada con tama&#241;o ventricular normal&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Aida Antu&#241;a Ramos, Juan Mayordomo-Colunga, Raquel Blanco Lago, Marco Antonio &#193;lvarez Vega"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Aida"
              "apellidos" => "Antu&#241;a Ramos"
            ]
            1 => array:2 [
              "nombre" => "Juan"
              "apellidos" => "Mayordomo-Colunga"
            ]
            2 => array:2 [
              "nombre" => "Raquel"
              "apellidos" => "Blanco Lago"
            ]
            3 => array:2 [
              "nombre" => "Marco Antonio"
              "apellidos" => "&#193;lvarez Vega"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2529849624000479"
        "doi" => "10.1016/j.neucie.2024.07.008"
        "estado" => "S200"
        "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/S2529849624000479?idApp=UINPBA00004B"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147324000769?idApp=UINPBA00004B"
    "url" => "/11301473/0000003500000006/v1_202411050451/S1130147324000769/v1_202411050451/es/main.assets"
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>"
    "titulo" => "Cervical spine spondylodiscitis due to neglected esophageal perforation after a dilation procedure 30 years after a laringectomy and radiotherapy&#46; Report of a case and review of literature"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "334"
        "paginaFinal" => "339"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Caribay Vargas-Rever&#243;n, Ernesto Mu&#241;oz-Mahamud, Alex Soriano, Andr&#233;s Combalia"
        "autores" => array:4 [
          0 => array:3 [
            "nombre" => "Caribay"
            "apellidos" => "Vargas-Rever&#243;n"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Ernesto"
            "apellidos" => "Mu&#241;oz-Mahamud"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Alex"
            "apellidos" => "Soriano"
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
          3 => array:4 [
            "nombre" => "Andr&#233;s"
            "apellidos" => "Combalia"
            "email" => array:1 [
              0 => "combalia@ub.edu"
            ]
            "referencia" => array:5 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
              3 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
              4 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:5 [
          0 => array:3 [
            "entidad" => "Servei de Cirurgia Ortop&#232;dica i Traumatologia&#44; Hospital Cl&#237;nic de Barcelona&#44; Universitat de Barcelona &#40;UB&#41;&#44; Barcelona&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Departament de Cirurgia i Especialitats Medicoquir&#250;rgiques&#44; Facultat de Medicina i Ci&#232;ncies de la Salut&#44; Universitat de Barcelona &#40;UB&#41;&#44; Barcelona&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Department of Infectious Diseases&#44; Bone and Joint Infection Unit&#44; Hospital Cl&#237;nic of Barcelona&#44; University of Barcelona&#44; Barcelona&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Institut d&#8217;Investigacions Biom&#232;diques August Pi i Sunyer &#40;IDIBAPS&#41;&#44; Barcelona&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Facultat de Medicina i Ci&#232;ncies de la Salut&#44; Universitat de Barcelona &#40;UB&#41;&#44; Barcelona&#44; Spain"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
        ]
        "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" => "Espondilodiscitis del raquis cervical debida a perforaci&#243;n esof&#225;gica tras una dilataci&#243;n esof&#225;gica 30 a&#241;os despu&#233;s de una laringectom&#237;a y radioterapia&#46; Reporte de un caso y revisi&#243;n de la literatura"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1465
            "Ancho" => 3341
            "Tamanyo" => 414874
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0025"
            "detalle" => "Fig&#46; "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">A&#46;</span> Cervical lateral radiograph&#58; hypodense lesions of C5&#47;C6 vertebral bodies with slight listhesis from C4 to C5&#46; Prevertebral calcification is compatible with abscess formation and increased anterior soft tissue volume &#40;arrows&#41;&#59; <span class="elsevierStyleBold">B&#46;</span> Cervical lateral computed tomography shows erosion and radiolucency of the anterior aspect of C5&#47;C6 vertebral bodies &#40;arrow&#41;&#59; <span class="elsevierStyleBold">C and D&#46;</span> Cervical sagittal T2 and STIR weighted contrast magnetic resonance showing prevertebral collection&#44; increased prevertebral space &#40;double arrow&#41; associated with osteomyelitic signs in the C5&#47;C6 vertebrae&#44; sinus tract from the esophagus and epidural abscess with mild obliteration signs of the spinal cord &#40;arrow&#41;&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Esophageal stenosis is a common complication of laryngeal cancer treatments&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> commonly requiring repeated bougie dilations&#46; Esophageal perforations are rare &#40;0&#46;04&#8722;0&#46;40&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Subsequent spondylodiscitis and epidural abscess are even rarer&#44; exceptionally reported&#44; with only few cases in the literature to our knowledge&#46; The treatment of this condition&#44; in this selected group of patients&#44; where it is usual to have anterior neck soft tissue problems due to previous surgical approaches and radiation therapy&#44; can become a challenge for the surgeon&#44; limiting the usual management of other causes of spondylodiscitis where an anterior approach debridement and fixation would surely be the first option&#46; We present the first case published&#44; to the best of our knowledge&#44; of successful treatment by posterior fixation and specific intravenous antibiotic therapy&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case description</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 75-year-old male with a history of larynx carcinoma treated with laryngectomy and radiotherapy 30 years earlier&#44; with the consequent deterioration of soft tissues of the anterior neck and progressive esophagus stricture secondary to the treatment&#44; leading to multiple esophageal dilations&#46; Four weeks after an apparently uneventful dilation procedure&#44; the patient consulted at the Emergency Department for neck stiffness&#44; pain and fever&#46; At admission in the infectious disease department&#44; he presented weakness to left shoulder abduction &#40;M&#58;3&#47;5&#41;&#46; Leukocytosis &#40;18&#44;690&#47;mL&#41; and elevated C-reactive-protein &#40;25&#46;55&#8201;mg&#47;dl&#44; normal &#60;1&#8201;mg&#47;dl&#41; were remarkable&#46; Lumbar puncture showed hypoglycorrhachia &#40;3&#8201;mg&#47;dl&#41; and an elevated protein count &#40;883&#8201;mg&#47;dl&#41;&#46; Blood cultures were positive for Peptostreptococcus&#46; Bacterial meningitis was the initial diagnosis in the medical department and was treated with antibiotics according to sensitivity without improvement&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Further image studies were performed&#46; Cervical X-ray showed hypodense areas of C5&#47;C6 vertebral bodies and prevertebral calcification compatible with an abscess &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; Computed tomography &#40;CT&#41; demonstrated a prevertebral collection and a radiolucency of anterior cortical margin of C5-C6 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; Magnetic resonance imaging &#40;MRI&#41; reported a prevertebral collection with sinus tract from the esophagus&#44; C5&#47;C6 osteomyelitis and an epidural abscess with subarachnoid space occupancy and associated increased uptake of cervicodorsal perimedular ependyma &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#46; The patient developed a spondylodiscitis and epidural abscess after a previous&#44; four weeks before&#44; neglected esophageal perforation&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Patient received treatment with antibiotics and a Philadelphia collar after his admission&#46; Ten days later&#44; without clinical improvement of shoulder abduction we consider the need for a surgical debridement&#46; Surgical treatment for spondylodiscitis is usually performed through an anterior approach that involves debridement&#44; vertebral body curettage or resection and anterior fixation and fusion&#46; However&#44; in the reported patient&#44; after careful evaluation of the serious soft tissue-damaged state of the anterior neck&#44; the option of doing an anterior approach was discarded&#46; The option of a conservative management with a cervical collar was discarded due to the risk of progressive neurological deterioration&#46; The patient was treated with a posterior approach and fixation by bilateral facet joints C4-C6 and pedicle C7 screws without debridement&#44; associated with 8 weeks of antibiotics&#46; A nasogastric tube was placed in the esophagus for parenteral nutrition during this period although the dilaceration caused by the dilation was probably closed spontaneously&#46; The patient showed progressive improvement&#44; regaining strength in the upper limb &#40;M&#58; 4&#47;5&#41;&#46; A 6-month control MRI showed resolution of C5&#47;C6 osteomyelitis and no evidence of abscesses or sinus tracts&#44; although it showed intramedullary expansive high signal &#40;C4-T11&#41;&#44; anterior medullary synechiae&#44; and persistent dural and arachnoid enhancement throughout the cord &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; After 6 months&#44; total strength was regained without signs of infectious processes after an 8-year follow-up&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">Management of laryngeal tumors is often complicated by esophageal stricture&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> particularly if radiation therapy has been associated&#44; requiring dilations and causing microtrauma that could induce direct inoculation of intestinal bacteria into adjacent tissues&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> An even more threatening complication is a perforation&#46; The Killian triangle is an anatomically weak area &#40;between the inferior pharyngeal constrictor and the cricopharyngeous muscle&#41; more susceptible to perforations&#46; Its proximity to C4&#8211;C6 vertebrae places them at high risk of infection by direct inoculation of bacteria through esophageal perforation&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Several causes of direct inoculation of bacteria into adjacent tissues of the cervical spine with subsequent infection secondary to esophageal injuries have been reported&#44; such as esophageal diverticulitis&#44; spontaneous rupture&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> complications of stent placements&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> gastrointestinal endoscopies&#44; anterior cervical fusions<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> traumatic esophageal injuries<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;10</span></a> and or surgical procedures as a pharyngolaryngectomy&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Spondylodiscitis after perforations as a consequence of esophageal dilations is exceptionally described in the literature&#46; Ekbom first reported a case of cervical spondylodiscitis and epidural abscess after a dilation with paresis of an upper extremity&#44; managed with posterior drainage of the abscess that later recurred&#46; Needing further treatment &#40;anterior approach&#44; corpectomy and fusion&#41; nevertheless&#44; cerebrospinal leakage and a persistent fistula developed &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Later&#44; Radulovic reported another case of perforation&#44; causing a rapidly progressive infection&#44; with neurological involvement that underwent drainage of the abscess&#44; with a good outcome after 6 weeks of antibiotics&#46; At two-year follow-up&#44; spontaneous fusion of intervertebral bodies &#40;C2-C4&#41; and paresis of the deltoid muscle were present&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> D&#8217;Souza reported 4 cases of cervical spondylodiscitis after reviewing 1221 patients with esophageal dilations&#59; of these&#44; only one had neurological involvement&#46; All were surgically managed with debridement and stabilization&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Neglecting epidural abscesses related to spondylodiscitis is likely considering its uncommon occurrence and initial subtle symptoms&#44; presenting the classic triad &#40;localized pain&#44; neurologic deficit and fever&#41; only in 37&#37; of the cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#8211;14</span></a> After onset of neurological symptoms&#44; a rapid progressive compression of neurovascular structures can be expected without rapid intervention&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;14</span></a> Although in some series there was no neurological impairment&#44; the incidence of neurological deficit ranges from 40 to 55 &#37; of cervical spondylodiscitis cases reported in the literature&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Management of spondylodiscitis depends on potential instability&#44; the presence of neurological and progressive symptoms&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> and the overall state of the patient&#46; Conservative management includes intravenous antibiotics based on isolated bacteria&#44; analgesics and cervical bracing&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> Most authors recommend radical debridement&#44; stable reconstruction using anterior only surgery&#44; when needed&#44; and antibiotic therapy&#46; Management of cervical epidural abscesses remains controversial&#46; Most authors recommend immediate decompression and drainage due to the potential risk of expansion&#44; secondary neurological compression and vascular thrombosis&#46; The prognosis of epidural abscesses is inversely proportionate to the duration and severity of symptoms&#46; However&#44; medical management is still a viable option when the infectious germ has been identified&#44; if strict vigilance is ensured&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;15</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In the reported case&#44; the usual management would have been to perform an anterior debridement and instrumentation&#46; However&#44; considering the status of the prevertebral cervical skin and soft tissues with fibrosis and adherence related to the history of radiotherapy and surgery&#44; the presence of a traqueostomy&#44; and having identified the infecting bacteria by blood cultures&#44; we decided to perform a posterior cervical instrumentation to stabilize and fix the affected spinal segment and the use of intravenous antibiotic therapy for four weeks that was followed by another 4 weeks of oral antibiotics&#44; obtaining a complete resolution of the infection&#46; An anterior approach&#44; regardless of its difficulty in the case presented&#44; could have been the source of multiple further complications&#44; including greater esophageal perforation&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusions</span><p id="par0055" class="elsevierStylePara elsevierViewall">In cases of spondylodiscitis and epidural abscess&#44; usual management would be anterior debridement and instrumentation&#46; However&#44; after considering the status of prevertebral cervical tissues with fibrosis&#44; adherences related to the history of radiotherapy and surgery&#44; the presence of traqueostomy&#44; and identified infecting bacteria&#44; a posterior fixation without anterior debridement and intravenous antibiotic specific therapy can could be a successful treatment&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Ethics approval</span><p id="par0060" class="elsevierStylePara elsevierViewall">This study was performed in line with the principles of the Declaration of Helsinki&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Consent to participate</span><p id="par0065" class="elsevierStylePara elsevierViewall">According to Institutional Review Board&#44; the informed consent is not required&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Consent for publication</span><p id="par0070" class="elsevierStylePara elsevierViewall">Authors consent to publish this report in NEUROCIRUGIA &#40;ASTUR&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors have no relevant financial or non-financial interests to disclose&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Funding</span><p id="par0080" class="elsevierStylePara elsevierViewall">This research did not receive specific support from public sector agencies&#44; the commercial sector&#44; or non-profit organizations&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Availability of data and material</span><p id="par0085" class="elsevierStylePara elsevierViewall">Not applicable&#46; All data are in the text</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Code availability</span><p id="par0090" class="elsevierStylePara elsevierViewall">Not applicable&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Authors&#39; contributions</span><p id="par0095" class="elsevierStylePara elsevierViewall">All authors contributed equally to this paper&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:17 [
        0 => array:3 [
          "identificador" => "xres2292617"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1905268"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres2292618"
          "titulo" => "Resumen"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1905267"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Case description"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Discussion"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Conclusions"
        ]
        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Ethics approval"
        ]
        9 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Consent to participate"
        ]
        10 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Consent for publication"
        ]
        11 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Conflicts of interest"
        ]
        12 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Funding"
        ]
        13 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Availability of data and material"
        ]
        14 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Code availability"
        ]
        15 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Authors&#39; contributions"
        ]
        16 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2024-05-22"
    "fechaAceptado" => "2024-08-12"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1905268"
          "palabras" => array:3 [
            0 => "Cervical spine spondylodiscitis"
            1 => "Esophageal perforation"
            2 => "Epidural abscess"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1905267"
          "palabras" => array:3 [
            0 => "Espondilodiscitis raquis cervical"
            1 => "Perforaci&#243;n esof&#225;gica"
            2 => "Abceso epidural"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Current treatment of cervical spine spondylodiscitis generally involves a radical surgical debridement and stable reconstruction together with antibiotic therapy until complete healing&#46; But this classical approach could be difficult for patients who have been treated previously for an esophageal carcinoma and received radiotherapy&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">We present a case of a 75-year-old male who underwent an esophageal dilation procedure and developed afterward a spondylodiscitis with epidural abscess due to a neglected esophageal perforation&#46; Blood cultures were positive for Peptostreptococcus&#46; Cervical spondylodiscitis and epidural abscess are extremely rare complications of esophageal dilations&#46; Successful treatment without debridement was achieved by performing a posterior fixation without decompression associated with antibiotic therapy for 8 weeks&#46; The present case highlights that spondylodiscitis and epidural abscess may be treated in selected cases where the anterior neck is unapproachable and with a recognized pathogen by a posterior approach fixation without debridement&#44; in association to specific antibiotic therapy&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El tratamiento actual de la espondilodiscitis de la columna cervical implica generalmente un desbridamiento quir&#250;rgico radical y una reconstrucci&#243;n estable junto con un tratamiento antibi&#243;tico hasta la curaci&#243;n completa&#46; Pero este enfoque cl&#225;sico puede resultar dif&#237;cil para pacientes que han sido tratados previamente por un carcinoma de es&#243;fago y han recibido radioterapia&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Presentamos el caso de un var&#243;n de 75 a&#241;os a quien se le realiz&#243; un procedimiento de dilataci&#243;n esof&#225;gica y posteriormente desarroll&#243; una espondilodiscitis con absceso epidural debido a una perforaci&#243;n esof&#225;gica desapercibida&#46; Los hemocultivos fueron positivos para Peptostreptococcus&#46; La espondilodiscitis cervical y el absceso epidural son complicaciones extremadamente raras de las dilataciones esof&#225;gicas&#46; El tratamiento exitoso sin desbridamiento se logr&#243; mediante la realizaci&#243;n de una fijaci&#243;n posterior sin descompresi&#243;n asociada a terapia con antibi&#243;ticos durante 8 semanas&#46; El presente caso destaca que la espondilodiscitis y el absceso epidural pueden tratarse en casos seleccionados donde la regi&#243;n cervical anterior es inaccesible y con un pat&#243;geno reconocido mediante una fijaci&#243;n posterior sin desbridamiento ni descompresi&#243;n&#44; asociado a una terapia antibi&#243;tica espec&#237;fica&#46;</p></span>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1465
            "Ancho" => 3341
            "Tamanyo" => 414874
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0025"
            "detalle" => "Fig&#46; "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">A&#46;</span> Cervical lateral radiograph&#58; hypodense lesions of C5&#47;C6 vertebral bodies with slight listhesis from C4 to C5&#46; Prevertebral calcification is compatible with abscess formation and increased anterior soft tissue volume &#40;arrows&#41;&#59; <span class="elsevierStyleBold">B&#46;</span> Cervical lateral computed tomography shows erosion and radiolucency of the anterior aspect of C5&#47;C6 vertebral bodies &#40;arrow&#41;&#59; <span class="elsevierStyleBold">C and D&#46;</span> Cervical sagittal T2 and STIR weighted contrast magnetic resonance showing prevertebral collection&#44; increased prevertebral space &#40;double arrow&#41; associated with osteomyelitic signs in the C5&#47;C6 vertebrae&#44; sinus tract from the esophagus and epidural abscess with mild obliteration signs of the spinal cord &#40;arrow&#41;&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1426
            "Ancho" => 1675
            "Tamanyo" => 194089
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0030"
            "detalle" => "Fig&#46; "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">A</span>&#46; Lateral cervical radiograph at six months post-operation&#58; posterior fixation with bilateral facet screws at C4-C5-C6 and pedicle screws at C7 six months after surgery&#59; <span class="elsevierStyleBold">B&#46;</span> MRI at 6 moths post- operation showed resolution of C5&#47;C6 osteomyelitis and no evidence of abscesses or sinus tracts&#44; although it showed intramedullary expansive high signal &#40;C4-T11&#41;&#44; anterior medullary synechiae&#44; and persistent dural and arachnoid enhancement throughout the cord&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0035"
            "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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Author year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">AgeSex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Primary disease and treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ClinicalPresentation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Management andOutcome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ekbom et al&#46;&#44; 2005<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Subglottic laryngeal cancer&#46;Radiation and laryngectomy with pharyngoesophageal stricture&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Progressive neck and shoulder pain&#44; headache&#44; vomiting&#44; altered mental status and decreased flexion strength in the upper extremity&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Epidural abscess from C2-C6 with involvement of vertebral bodies of C4-C6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 surgical procedures&#58; drainage&#44; laminectomy&#44; anterior&#47;posterior fusion&#44; fistula closure for multiple clinical relapses and cerebrospinal leakage&#46; Remaining with left extremity paresis&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Raduvolic &#38; Vujotic&#44; 2012<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Unremarkable past medical history with swallowing problems&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cervical sharp pain during endoscopy&#46; Over the following 2 weeks the patient developed intermittent fever&#44; chills and neck pain&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Osteomyelitis of the C3-C4 vertebral bodies with infection of the C3-C4 disc space and epidural abscess with no germ isolated&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Emergent C2-C4 laminectomy and abscess drainage was performed &#40;after progression to quadriparesia&#41;&#46; Broad spectrum antibiotic for 6 weeks&#46;Remaining right deltoid paresis&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="4" align="left" valign="middle">D&#8217;Souza et al&#46;&#44; 2016<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#8201;sMale&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Recurrent laryngeal cancerRadiation and laryngectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neck pain and fever&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Progressive destruction of cervical vertebral bodies and epidural abscess of a polymicrobial origin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Debridement with discectomy&#44; iliac crest graft&#44; immobilization with halo&#46; 6 weeks of intravenous antibiotic therapy&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70sMale&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Laryngeal cancerRadiation and laryngectomy hypopharyngeal stricture&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neck pain&#44; fever&#44; hypotension bacteremia&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C6-C7 epidural abscess and vertebral bodies involvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Debridement with discectomy&#44; iliac crest graft and posterior cervical fusion&#46;6 weeks of intravenous antibiotic therapy&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60sMale&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Squamous cell carcinoma of the pyriform sinus&#46;Transoral robotic resection and chemotherapy&#46;Hypopharyngeal stricture&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fever&#44; upper extremity weakness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C3-C4 epidural abscess&#44; vertebral bodies destruction and dyscitis&#46; Eikenella corrodens&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Debridement with discectomy&#44; iliac crest graft and posterior cervical fusion&#46;6 weeks of intravenous antibiotic therapy&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70sMale&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tongue base cancerRadiation&#44; recurrent laryngeal cancer treated with laryngectomy&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Incidental finding on PET-CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C5-C6 Cervical spine spondylodiscitis&#46; Pseudomona aeruginosa&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Debridement with discectomy&#44; iliac crest graft and posterior cervical fusion&#46;6 weeks of intravenous antibiotic therapy&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3715531.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Reported cases of cervical spondylodyscitis or epidural abscess related to esophageal dilations&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:15 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cervical spondylodiscitis after esophageal dilation in patients with a history of laryngectomy or pharyngectomy and pharyngeal irradiation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; D&#8217;Souza"
                            1 => "J&#46; Luginbuhl"
                            2 => "R&#46; Goldman"
                            3 => "E&#46; Joshua"
                            4 => "J&#46; Curry"
                            5 => "D&#46; Cognetti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jamaoto.2015.3038"
                      "Revista" => array:7 [
                        "tituloSerie" => "JAMA Otolaryngol Head Neck Surg"
                        "fecha" => "2016"
                        "volumen" => "142"
                        "numero" => "5"
                        "paginaInicial" => "467"
                        "paginaFinal" => "471"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27010455"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spinal epidural abscess after cervical pharyngoesophageal dilation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "D&#46; Ekbom"
                            1 => "J&#46; D-Elia"
                            2 => "B&#46; Isaacson"
                            3 => "F&#46; LaMarca"
                            4 => "D&#46; Chepeha"
                            5 => "C&#46; Bradford"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Head Neck"
                        "fecha" => "2005"
                        "volumen" => "27"
                        "paginaInicial" => "543"
                        "paginaFinal" => "548"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Proximal esophageal stenosis in head and neck cancer patients after total laryngectomy and radiation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;N&#46; Vu"
                            1 => "T&#46;A&#46; Day"
                            2 => "M&#46;B&#46; Gillespie"
                            3 => "B&#46; Martin-Harris"
                            4 => "D&#46; Sinha"
                            5 => "R&#46;K&#46; Stuart"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000130870"
                      "Revista" => array:7 [
                        "tituloSerie" => "ORL J Otorhinolaryngol Relat Spec"
                        "fecha" => "2008"
                        "volumen" => "70"
                        "numero" => "4"
                        "paginaInicial" => "229"
                        "paginaFinal" => "235"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18467817"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cervical epidural abscess and vertebral osteomyelitis following non-traumatic oesophageal rupture&#58; a case report and discussion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46; Metcalfe"
                            1 => "C&#46; Morgan-Hough"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00586-009-0889-9"
                      "Revista" => array:7 [
                        "tituloSerie" => "Eur Spine J"
                        "fecha" => "2009"
                        "volumen" => "18"
                        "numero" => "Suppl 2"
                        "paginaInicial" => "224"
                        "paginaFinal" => "227"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19184129"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cervical osteomyelitis after placement of a self-expanding plastic stent for palliation of dysphagia associated with chemoradiation-induced esophageal structures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46; Mullen"
                            1 => "A&#46; Sharma"
                            2 => "A&#46; Vamma"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/hed.22975"
                      "Revista" => array:7 [
                        "tituloSerie" => "Head Neck"
                        "fecha" => "2013"
                        "volumen" => "35"
                        "numero" => "6"
                        "paginaInicial" => "E197"
                        "paginaFinal" => "201"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22367919"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cervical Spondylodiscitis associated with esophageal perforation&#58; a rare complication after anterior cervical fusion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46; Korovessis"
                            1 => "T&#46; Repantis"
                            2 => "V&#46; Vistas"
                            3 => "K&#46; Vardakastanis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00590-012-1092-y"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Orthop Surg Traumatol"
                        "fecha" => "2013"
                        "volumen" => "23 Suppl 2"
                        "paginaInicial" => "S159"
                        "paginaFinal" => "63"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23412223"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Upper cervical spine infection&#46; Complication of hypopharyngeal injury"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46; Skaf"
                            1 => "E&#46; Elias"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4236/ijohns.2016.52016"
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Otorhinolaryngol Head Neck Surg"
                        "fecha" => "2016"
                        "volumen" => "05"
                        "paginaInicial" => "96"
                        "paginaFinal" => "102"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spinal epidural abscess presenting with paraplegia following delayed presentation of traumatic esophageal perforation without spinal fracture&#58; lessons to be learnt"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46;D&#46; Baron"
                            1 => "D&#46; Pal"
                            2 => "D&#46;W&#46; Crimmins"
                            3 => "S&#46;P&#46; Dexter"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00068-009-8225-y"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Trauma Emerg Surg"
                        "fecha" => "2010"
                        "volumen" => "36"
                        "paginaInicial" => "247"
                        "paginaFinal" => "249"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26815868"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Infectious spondylodiscitis caused by esophageal injury after blunt chest trauma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;Y&#46; Park"
                            1 => "H&#46;K&#46; Chung"
                            2 => "K&#46;W&#46; Yoon"
                            3 => "S&#46;I&#46; Jung"
                            4 => "C&#46;H&#46; Park"
                            5 => "Y&#46;E&#46; Joo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.gie.2010.02.025"
                      "Revista" => array:7 [
                        "tituloSerie" => "Gastrointest Endosc"
                        "fecha" => "2010"
                        "volumen" => "72"
                        "numero" => "5"
                        "paginaInicial" => "1095"
                        "paginaFinal" => "1097"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20541194"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Esophageal perforation complicating with spinal epidural abscess&#44; iatrogenic or secondary to first thoracic spine fracture&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "H&#46;C&#46; Chen"
                            1 => "W&#46;C&#46; Tzaan"
                            2 => "T&#46;Y&#46; Chen"
                            3 => "P&#46;H&#46; Tu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00701-004-0305-5"
                      "Revista" => array:7 [
                        "tituloSerie" => "Acta Neurochir &#40;Wien&#41;"
                        "fecha" => "2005"
                        "volumen" => "147"
                        "paginaInicial" => "431"
                        "paginaFinal" => "434"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15785966"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0092867423000053"
                          "estado" => "S300"
                          "issn" => "00928674"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#40;2016&#41; Cervical spondylodiscitis following an invasive procedure on the neopharynx after circumferential pharyngolaryngectomy&#58; a retrospective case series"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Espitalier"
                            1 => "A&#46; Keating-Hart"
                            2 => "S&#46; Morini&#232;re"
                            3 => "J&#46;M&#46; Badet"
                            4 => "N&#46; Asseray"
                            5 => "C&#46; Ferron"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00586-016-4741-8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Spine J"
                        "fecha" => "2016"
                        "volumen" => "25"
                        "paginaInicial" => "3894"
                        "paginaFinal" => "3901"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27566300"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cervical spinal epidural abscess after esophagoscopy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46; Radulovic"
                            1 => "L&#46; Vujotic"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00586-012-2478-6"
                      "Revista" => array:7 [
                        "tituloSerie" => "Eur Spine J"
                        "fecha" => "2013"
                        "volumen" => "22"
                        "numero" => "3"
                        "paginaInicial" => "S369"
                        "paginaFinal" => "S372"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22918512"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A rare complication of esophageal stent&#58; spinal epidural abscess"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46;Y&#46; Li"
                            1 => "W&#46;C&#46; Chen"
                            2 => "S&#46;S&#46; Yang"
                            3 => "Y&#46; Lee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2009.02.079"
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2009"
                        "volumen" => "88"
                        "numero" => "5"
                        "paginaInicial" => "1700"
                        "paginaFinal" => "1702"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19853149"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Latent spinal epidural abscess revealed 4 months after esophageal perforation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "E&#46; Condrea"
                            1 => "D&#46; Lisii"
                            2 => "V&#46; Timirgaz"
                            3 => "I&#46; Codreanu"
                            4 => "N&#46; Rotaru"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.spinee.2014.07.012"
                      "Revista" => array:7 [
                        "tituloSerie" => "Spine J"
                        "fecha" => "2014"
                        "volumen" => "14"
                        "numero" => "12"
                        "paginaInicial" => "3054"
                        "paginaFinal" => "3055"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25088959"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Successful conservative management of delayed cervical spondylodiscitis with epidural abscess caused by esophageal diverticulitis&#58; a case report and review of literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Ying"
                            1 => "S&#46; Pei"
                            2 => "L&#46; Su"
                            3 => "T&#46; Wen"
                            4 => "Y&#46; Lv"
                            5 => "D&#46; Ruan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.wneu.2018.05.207"
                      "Revista" => array:6 [
                        "tituloSerie" => "World Neurosurg"
                        "fecha" => "2018"
                        "volumen" => "118"
                        "paginaInicial" => "250"
                        "paginaFinal" => "260"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29883818"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/11301473/0000003500000006/v1_202411050451/S1130147324000897/v1_202411050451/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/11301473/0000003500000006/v1_202411050451/S1130147324000897/v1_202411050451/en/main.pdf?idApp=UINPBA00004B&text.app=https://revistaneurocirugia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147324000897?idApp=UINPBA00004B"
]
Compartir
Información de la revista

Estadísticas

Siga este enlace para acceder al texto completo del artículo

Case Report
Cervical spine spondylodiscitis due to neglected esophageal perforation after a dilation procedure 30 years after a laringectomy and radiotherapy. Report of a case and review of literature
Espondilodiscitis del raquis cervical debida a perforación esofágica tras una dilatación esofágica 30 años después de una laringectomía y radioterapia. Reporte de un caso y revisión de la literatura
Caribay Vargas-Reveróna, Ernesto Muñoz-Mahamuda,b, Alex Sorianoc,d,e, Andrés Combaliaa,b,d,e,
Autor para correspondencia
combalia@ub.edu

Corresponding author.
a Servei de Cirurgia Ortopèdica i Traumatologia, Hospital Clínic de Barcelona, Universitat de Barcelona (UB), Barcelona, Spain
b Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
c Department of Infectious Diseases, Bone and Joint Infection Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
d Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
e Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
Leído
10
Veces
se ha leído el artículo
0
Total PDF
10
Total HTML
Compartir estadísticas
 array:22 [
  "pii" => "S1130147324000897"
  "issn" => "11301473"
  "doi" => "10.1016/j.neucir.2024.08.001"
  "estado" => "S300"
  "fechaPublicacion" => "2024-11-01"
  "aid" => "624"
  "copyright" => "The Author&#40;s&#41;"
  "copyrightAnyo" => "2024"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "crp"
  "cita" => "Neurocirugia. 2024;35:334-9"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1130147324000769"
    "issn" => "11301473"
    "doi" => "10.1016/j.neucir.2024.07.003"
    "estado" => "S300"
    "fechaPublicacion" => "2024-11-01"
    "aid" => "619"
    "copyright" => "Sociedad Espa&#241;ola de Neurocirug&#237;a"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Neurocirugia. 2024;35:329-33"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "es" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Caso cl&#237;nico</span>"
      "titulo" => "Papel de la craniectom&#237;a descompresiva en el edema cerebral fulminante agudo"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "329"
          "paginaFinal" => "333"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Decompressive craniectomy in the acute fulminant cerebral edema"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figura 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 693
              "Ancho" => 1801
              "Tamanyo" => 127779
            ]
          ]
          "descripcion" => array:1 [
            "es" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Im&#225;genes de resonancia en T2&#46; Tumefacci&#243;n del par&#233;nquima frontotemporal&#46; A&#41; Axial a las 72 horas&#46; B&#41; Coronal a las 72 horas&#46; Cambios secundarios a craniectom&#237;a bifrontal&#46; En ambos cortes se observa una importante y extensa tumefacci&#243;n&#44; con hiperse&#241;al en secuencias potenciadas en T2&#46; Afecta a los n&#250;cleos caudados y put&#225;menes respetando t&#225;lamo&#44; corteza occipitoparietal y cerebelo&#46; Los hallazgos son compatibles con encefalitis&#44; sin un patr&#243;n que sugiera una etiolog&#237;a concreta&#46; C&#41; Corte axial al nivel de la imagen en A&#44; tras la cirug&#237;a de craneoplastia a los 21 d&#237;as tras la cirug&#237;a descompresiva&#46; Aumento difuso de la se&#241;al en T2 y en localizaci&#243;n cortical&#44; subcortical y en menor medida en la sustancia blanca de los l&#243;bulos frontales y parietales y parcheado en los l&#243;bulos occipitales y temporales&#46; En los l&#243;bulos frontales se observan signos de p&#233;rdida de volumen&#46; L&#237;nea media centrada con tama&#241;o ventricular normal&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Aida Antu&#241;a Ramos, Juan Mayordomo-Colunga, Raquel Blanco Lago, Marco Antonio &#193;lvarez Vega"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Aida"
              "apellidos" => "Antu&#241;a Ramos"
            ]
            1 => array:2 [
              "nombre" => "Juan"
              "apellidos" => "Mayordomo-Colunga"
            ]
            2 => array:2 [
              "nombre" => "Raquel"
              "apellidos" => "Blanco Lago"
            ]
            3 => array:2 [
              "nombre" => "Marco Antonio"
              "apellidos" => "&#193;lvarez Vega"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2529849624000479"
        "doi" => "10.1016/j.neucie.2024.07.008"
        "estado" => "S200"
        "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/S2529849624000479?idApp=UINPBA00004B"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147324000769?idApp=UINPBA00004B"
    "url" => "/11301473/0000003500000006/v1_202411050451/S1130147324000769/v1_202411050451/es/main.assets"
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>"
    "titulo" => "Cervical spine spondylodiscitis due to neglected esophageal perforation after a dilation procedure 30 years after a laringectomy and radiotherapy&#46; Report of a case and review of literature"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "334"
        "paginaFinal" => "339"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Caribay Vargas-Rever&#243;n, Ernesto Mu&#241;oz-Mahamud, Alex Soriano, Andr&#233;s Combalia"
        "autores" => array:4 [
          0 => array:3 [
            "nombre" => "Caribay"
            "apellidos" => "Vargas-Rever&#243;n"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Ernesto"
            "apellidos" => "Mu&#241;oz-Mahamud"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Alex"
            "apellidos" => "Soriano"
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
          3 => array:4 [
            "nombre" => "Andr&#233;s"
            "apellidos" => "Combalia"
            "email" => array:1 [
              0 => "combalia@ub.edu"
            ]
            "referencia" => array:5 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
              3 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
              4 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:5 [
          0 => array:3 [
            "entidad" => "Servei de Cirurgia Ortop&#232;dica i Traumatologia&#44; Hospital Cl&#237;nic de Barcelona&#44; Universitat de Barcelona &#40;UB&#41;&#44; Barcelona&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Departament de Cirurgia i Especialitats Medicoquir&#250;rgiques&#44; Facultat de Medicina i Ci&#232;ncies de la Salut&#44; Universitat de Barcelona &#40;UB&#41;&#44; Barcelona&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Department of Infectious Diseases&#44; Bone and Joint Infection Unit&#44; Hospital Cl&#237;nic of Barcelona&#44; University of Barcelona&#44; Barcelona&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Institut d&#8217;Investigacions Biom&#232;diques August Pi i Sunyer &#40;IDIBAPS&#41;&#44; Barcelona&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Facultat de Medicina i Ci&#232;ncies de la Salut&#44; Universitat de Barcelona &#40;UB&#41;&#44; Barcelona&#44; Spain"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
        ]
        "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" => "Espondilodiscitis del raquis cervical debida a perforaci&#243;n esof&#225;gica tras una dilataci&#243;n esof&#225;gica 30 a&#241;os despu&#233;s de una laringectom&#237;a y radioterapia&#46; Reporte de un caso y revisi&#243;n de la literatura"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1465
            "Ancho" => 3341
            "Tamanyo" => 414874
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0025"
            "detalle" => "Fig&#46; "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">A&#46;</span> Cervical lateral radiograph&#58; hypodense lesions of C5&#47;C6 vertebral bodies with slight listhesis from C4 to C5&#46; Prevertebral calcification is compatible with abscess formation and increased anterior soft tissue volume &#40;arrows&#41;&#59; <span class="elsevierStyleBold">B&#46;</span> Cervical lateral computed tomography shows erosion and radiolucency of the anterior aspect of C5&#47;C6 vertebral bodies &#40;arrow&#41;&#59; <span class="elsevierStyleBold">C and D&#46;</span> Cervical sagittal T2 and STIR weighted contrast magnetic resonance showing prevertebral collection&#44; increased prevertebral space &#40;double arrow&#41; associated with osteomyelitic signs in the C5&#47;C6 vertebrae&#44; sinus tract from the esophagus and epidural abscess with mild obliteration signs of the spinal cord &#40;arrow&#41;&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Esophageal stenosis is a common complication of laryngeal cancer treatments&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> commonly requiring repeated bougie dilations&#46; Esophageal perforations are rare &#40;0&#46;04&#8722;0&#46;40&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Subsequent spondylodiscitis and epidural abscess are even rarer&#44; exceptionally reported&#44; with only few cases in the literature to our knowledge&#46; The treatment of this condition&#44; in this selected group of patients&#44; where it is usual to have anterior neck soft tissue problems due to previous surgical approaches and radiation therapy&#44; can become a challenge for the surgeon&#44; limiting the usual management of other causes of spondylodiscitis where an anterior approach debridement and fixation would surely be the first option&#46; We present the first case published&#44; to the best of our knowledge&#44; of successful treatment by posterior fixation and specific intravenous antibiotic therapy&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case description</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 75-year-old male with a history of larynx carcinoma treated with laryngectomy and radiotherapy 30 years earlier&#44; with the consequent deterioration of soft tissues of the anterior neck and progressive esophagus stricture secondary to the treatment&#44; leading to multiple esophageal dilations&#46; Four weeks after an apparently uneventful dilation procedure&#44; the patient consulted at the Emergency Department for neck stiffness&#44; pain and fever&#46; At admission in the infectious disease department&#44; he presented weakness to left shoulder abduction &#40;M&#58;3&#47;5&#41;&#46; Leukocytosis &#40;18&#44;690&#47;mL&#41; and elevated C-reactive-protein &#40;25&#46;55&#8201;mg&#47;dl&#44; normal &#60;1&#8201;mg&#47;dl&#41; were remarkable&#46; Lumbar puncture showed hypoglycorrhachia &#40;3&#8201;mg&#47;dl&#41; and an elevated protein count &#40;883&#8201;mg&#47;dl&#41;&#46; Blood cultures were positive for Peptostreptococcus&#46; Bacterial meningitis was the initial diagnosis in the medical department and was treated with antibiotics according to sensitivity without improvement&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Further image studies were performed&#46; Cervical X-ray showed hypodense areas of C5&#47;C6 vertebral bodies and prevertebral calcification compatible with an abscess &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; Computed tomography &#40;CT&#41; demonstrated a prevertebral collection and a radiolucency of anterior cortical margin of C5-C6 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; Magnetic resonance imaging &#40;MRI&#41; reported a prevertebral collection with sinus tract from the esophagus&#44; C5&#47;C6 osteomyelitis and an epidural abscess with subarachnoid space occupancy and associated increased uptake of cervicodorsal perimedular ependyma &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#46; The patient developed a spondylodiscitis and epidural abscess after a previous&#44; four weeks before&#44; neglected esophageal perforation&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Patient received treatment with antibiotics and a Philadelphia collar after his admission&#46; Ten days later&#44; without clinical improvement of shoulder abduction we consider the need for a surgical debridement&#46; Surgical treatment for spondylodiscitis is usually performed through an anterior approach that involves debridement&#44; vertebral body curettage or resection and anterior fixation and fusion&#46; However&#44; in the reported patient&#44; after careful evaluation of the serious soft tissue-damaged state of the anterior neck&#44; the option of doing an anterior approach was discarded&#46; The option of a conservative management with a cervical collar was discarded due to the risk of progressive neurological deterioration&#46; The patient was treated with a posterior approach and fixation by bilateral facet joints C4-C6 and pedicle C7 screws without debridement&#44; associated with 8 weeks of antibiotics&#46; A nasogastric tube was placed in the esophagus for parenteral nutrition during this period although the dilaceration caused by the dilation was probably closed spontaneously&#46; The patient showed progressive improvement&#44; regaining strength in the upper limb &#40;M&#58; 4&#47;5&#41;&#46; A 6-month control MRI showed resolution of C5&#47;C6 osteomyelitis and no evidence of abscesses or sinus tracts&#44; although it showed intramedullary expansive high signal &#40;C4-T11&#41;&#44; anterior medullary synechiae&#44; and persistent dural and arachnoid enhancement throughout the cord &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; After 6 months&#44; total strength was regained without signs of infectious processes after an 8-year follow-up&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">Management of laryngeal tumors is often complicated by esophageal stricture&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> particularly if radiation therapy has been associated&#44; requiring dilations and causing microtrauma that could induce direct inoculation of intestinal bacteria into adjacent tissues&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> An even more threatening complication is a perforation&#46; The Killian triangle is an anatomically weak area &#40;between the inferior pharyngeal constrictor and the cricopharyngeous muscle&#41; more susceptible to perforations&#46; Its proximity to C4&#8211;C6 vertebrae places them at high risk of infection by direct inoculation of bacteria through esophageal perforation&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Several causes of direct inoculation of bacteria into adjacent tissues of the cervical spine with subsequent infection secondary to esophageal injuries have been reported&#44; such as esophageal diverticulitis&#44; spontaneous rupture&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> complications of stent placements&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> gastrointestinal endoscopies&#44; anterior cervical fusions<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> traumatic esophageal injuries<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;10</span></a> and or surgical procedures as a pharyngolaryngectomy&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Spondylodiscitis after perforations as a consequence of esophageal dilations is exceptionally described in the literature&#46; Ekbom first reported a case of cervical spondylodiscitis and epidural abscess after a dilation with paresis of an upper extremity&#44; managed with posterior drainage of the abscess that later recurred&#46; Needing further treatment &#40;anterior approach&#44; corpectomy and fusion&#41; nevertheless&#44; cerebrospinal leakage and a persistent fistula developed &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Later&#44; Radulovic reported another case of perforation&#44; causing a rapidly progressive infection&#44; with neurological involvement that underwent drainage of the abscess&#44; with a good outcome after 6 weeks of antibiotics&#46; At two-year follow-up&#44; spontaneous fusion of intervertebral bodies &#40;C2-C4&#41; and paresis of the deltoid muscle were present&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> D&#8217;Souza reported 4 cases of cervical spondylodiscitis after reviewing 1221 patients with esophageal dilations&#59; of these&#44; only one had neurological involvement&#46; All were surgically managed with debridement and stabilization&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Neglecting epidural abscesses related to spondylodiscitis is likely considering its uncommon occurrence and initial subtle symptoms&#44; presenting the classic triad &#40;localized pain&#44; neurologic deficit and fever&#41; only in 37&#37; of the cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#8211;14</span></a> After onset of neurological symptoms&#44; a rapid progressive compression of neurovascular structures can be expected without rapid intervention&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;14</span></a> Although in some series there was no neurological impairment&#44; the incidence of neurological deficit ranges from 40 to 55 &#37; of cervical spondylodiscitis cases reported in the literature&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Management of spondylodiscitis depends on potential instability&#44; the presence of neurological and progressive symptoms&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> and the overall state of the patient&#46; Conservative management includes intravenous antibiotics based on isolated bacteria&#44; analgesics and cervical bracing&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> Most authors recommend radical debridement&#44; stable reconstruction using anterior only surgery&#44; when needed&#44; and antibiotic therapy&#46; Management of cervical epidural abscesses remains controversial&#46; Most authors recommend immediate decompression and drainage due to the potential risk of expansion&#44; secondary neurological compression and vascular thrombosis&#46; The prognosis of epidural abscesses is inversely proportionate to the duration and severity of symptoms&#46; However&#44; medical management is still a viable option when the infectious germ has been identified&#44; if strict vigilance is ensured&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;15</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In the reported case&#44; the usual management would have been to perform an anterior debridement and instrumentation&#46; However&#44; considering the status of the prevertebral cervical skin and soft tissues with fibrosis and adherence related to the history of radiotherapy and surgery&#44; the presence of a traqueostomy&#44; and having identified the infecting bacteria by blood cultures&#44; we decided to perform a posterior cervical instrumentation to stabilize and fix the affected spinal segment and the use of intravenous antibiotic therapy for four weeks that was followed by another 4 weeks of oral antibiotics&#44; obtaining a complete resolution of the infection&#46; An anterior approach&#44; regardless of its difficulty in the case presented&#44; could have been the source of multiple further complications&#44; including greater esophageal perforation&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusions</span><p id="par0055" class="elsevierStylePara elsevierViewall">In cases of spondylodiscitis and epidural abscess&#44; usual management would be anterior debridement and instrumentation&#46; However&#44; after considering the status of prevertebral cervical tissues with fibrosis&#44; adherences related to the history of radiotherapy and surgery&#44; the presence of traqueostomy&#44; and identified infecting bacteria&#44; a posterior fixation without anterior debridement and intravenous antibiotic specific therapy can could be a successful treatment&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Ethics approval</span><p id="par0060" class="elsevierStylePara elsevierViewall">This study was performed in line with the principles of the Declaration of Helsinki&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Consent to participate</span><p id="par0065" class="elsevierStylePara elsevierViewall">According to Institutional Review Board&#44; the informed consent is not required&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Consent for publication</span><p id="par0070" class="elsevierStylePara elsevierViewall">Authors consent to publish this report in NEUROCIRUGIA &#40;ASTUR&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors have no relevant financial or non-financial interests to disclose&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Funding</span><p id="par0080" class="elsevierStylePara elsevierViewall">This research did not receive specific support from public sector agencies&#44; the commercial sector&#44; or non-profit organizations&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Availability of data and material</span><p id="par0085" class="elsevierStylePara elsevierViewall">Not applicable&#46; All data are in the text</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Code availability</span><p id="par0090" class="elsevierStylePara elsevierViewall">Not applicable&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Authors&#39; contributions</span><p id="par0095" class="elsevierStylePara elsevierViewall">All authors contributed equally to this paper&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:17 [
        0 => array:3 [
          "identificador" => "xres2292617"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1905268"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres2292618"
          "titulo" => "Resumen"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1905267"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Case description"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Discussion"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Conclusions"
        ]
        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Ethics approval"
        ]
        9 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Consent to participate"
        ]
        10 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Consent for publication"
        ]
        11 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Conflicts of interest"
        ]
        12 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Funding"
        ]
        13 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Availability of data and material"
        ]
        14 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Code availability"
        ]
        15 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Authors&#39; contributions"
        ]
        16 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2024-05-22"
    "fechaAceptado" => "2024-08-12"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1905268"
          "palabras" => array:3 [
            0 => "Cervical spine spondylodiscitis"
            1 => "Esophageal perforation"
            2 => "Epidural abscess"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1905267"
          "palabras" => array:3 [
            0 => "Espondilodiscitis raquis cervical"
            1 => "Perforaci&#243;n esof&#225;gica"
            2 => "Abceso epidural"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Current treatment of cervical spine spondylodiscitis generally involves a radical surgical debridement and stable reconstruction together with antibiotic therapy until complete healing&#46; But this classical approach could be difficult for patients who have been treated previously for an esophageal carcinoma and received radiotherapy&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">We present a case of a 75-year-old male who underwent an esophageal dilation procedure and developed afterward a spondylodiscitis with epidural abscess due to a neglected esophageal perforation&#46; Blood cultures were positive for Peptostreptococcus&#46; Cervical spondylodiscitis and epidural abscess are extremely rare complications of esophageal dilations&#46; Successful treatment without debridement was achieved by performing a posterior fixation without decompression associated with antibiotic therapy for 8 weeks&#46; The present case highlights that spondylodiscitis and epidural abscess may be treated in selected cases where the anterior neck is unapproachable and with a recognized pathogen by a posterior approach fixation without debridement&#44; in association to specific antibiotic therapy&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El tratamiento actual de la espondilodiscitis de la columna cervical implica generalmente un desbridamiento quir&#250;rgico radical y una reconstrucci&#243;n estable junto con un tratamiento antibi&#243;tico hasta la curaci&#243;n completa&#46; Pero este enfoque cl&#225;sico puede resultar dif&#237;cil para pacientes que han sido tratados previamente por un carcinoma de es&#243;fago y han recibido radioterapia&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Presentamos el caso de un var&#243;n de 75 a&#241;os a quien se le realiz&#243; un procedimiento de dilataci&#243;n esof&#225;gica y posteriormente desarroll&#243; una espondilodiscitis con absceso epidural debido a una perforaci&#243;n esof&#225;gica desapercibida&#46; Los hemocultivos fueron positivos para Peptostreptococcus&#46; La espondilodiscitis cervical y el absceso epidural son complicaciones extremadamente raras de las dilataciones esof&#225;gicas&#46; El tratamiento exitoso sin desbridamiento se logr&#243; mediante la realizaci&#243;n de una fijaci&#243;n posterior sin descompresi&#243;n asociada a terapia con antibi&#243;ticos durante 8 semanas&#46; El presente caso destaca que la espondilodiscitis y el absceso epidural pueden tratarse en casos seleccionados donde la regi&#243;n cervical anterior es inaccesible y con un pat&#243;geno reconocido mediante una fijaci&#243;n posterior sin desbridamiento ni descompresi&#243;n&#44; asociado a una terapia antibi&#243;tica espec&#237;fica&#46;</p></span>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1465
            "Ancho" => 3341
            "Tamanyo" => 414874
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0025"
            "detalle" => "Fig&#46; "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">A&#46;</span> Cervical lateral radiograph&#58; hypodense lesions of C5&#47;C6 vertebral bodies with slight listhesis from C4 to C5&#46; Prevertebral calcification is compatible with abscess formation and increased anterior soft tissue volume &#40;arrows&#41;&#59; <span class="elsevierStyleBold">B&#46;</span> Cervical lateral computed tomography shows erosion and radiolucency of the anterior aspect of C5&#47;C6 vertebral bodies &#40;arrow&#41;&#59; <span class="elsevierStyleBold">C and D&#46;</span> Cervical sagittal T2 and STIR weighted contrast magnetic resonance showing prevertebral collection&#44; increased prevertebral space &#40;double arrow&#41; associated with osteomyelitic signs in the C5&#47;C6 vertebrae&#44; sinus tract from the esophagus and epidural abscess with mild obliteration signs of the spinal cord &#40;arrow&#41;&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1426
            "Ancho" => 1675
            "Tamanyo" => 194089
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0030"
            "detalle" => "Fig&#46; "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">A</span>&#46; Lateral cervical radiograph at six months post-operation&#58; posterior fixation with bilateral facet screws at C4-C5-C6 and pedicle screws at C7 six months after surgery&#59; <span class="elsevierStyleBold">B&#46;</span> MRI at 6 moths post- operation showed resolution of C5&#47;C6 osteomyelitis and no evidence of abscesses or sinus tracts&#44; although it showed intramedullary expansive high signal &#40;C4-T11&#41;&#44; anterior medullary synechiae&#44; and persistent dural and arachnoid enhancement throughout the cord&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0035"
            "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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Author year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">AgeSex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Primary disease and treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ClinicalPresentation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Management andOutcome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ekbom et al&#46;&#44; 2005<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Subglottic laryngeal cancer&#46;Radiation and laryngectomy with pharyngoesophageal stricture&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Progressive neck and shoulder pain&#44; headache&#44; vomiting&#44; altered mental status and decreased flexion strength in the upper extremity&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Epidural abscess from C2-C6 with involvement of vertebral bodies of C4-C6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 surgical procedures&#58; drainage&#44; laminectomy&#44; anterior&#47;posterior fusion&#44; fistula closure for multiple clinical relapses and cerebrospinal leakage&#46; Remaining with left extremity paresis&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Raduvolic &#38; Vujotic&#44; 2012<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Unremarkable past medical history with swallowing problems&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cervical sharp pain during endoscopy&#46; Over the following 2 weeks the patient developed intermittent fever&#44; chills and neck pain&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Osteomyelitis of the C3-C4 vertebral bodies with infection of the C3-C4 disc space and epidural abscess with no germ isolated&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Emergent C2-C4 laminectomy and abscess drainage was performed &#40;after progression to quadriparesia&#41;&#46; Broad spectrum antibiotic for 6 weeks&#46;Remaining right deltoid paresis&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="4" align="left" valign="middle">D&#8217;Souza et al&#46;&#44; 2016<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#8201;sMale&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Recurrent laryngeal cancerRadiation and laryngectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neck pain and fever&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Progressive destruction of cervical vertebral bodies and epidural abscess of a polymicrobial origin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Debridement with discectomy&#44; iliac crest graft&#44; immobilization with halo&#46; 6 weeks of intravenous antibiotic therapy&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70sMale&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Laryngeal cancerRadiation and laryngectomy hypopharyngeal stricture&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neck pain&#44; fever&#44; hypotension bacteremia&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C6-C7 epidural abscess and vertebral bodies involvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Debridement with discectomy&#44; iliac crest graft and posterior cervical fusion&#46;6 weeks of intravenous antibiotic therapy&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60sMale&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Squamous cell carcinoma of the pyriform sinus&#46;Transoral robotic resection and chemotherapy&#46;Hypopharyngeal stricture&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fever&#44; upper extremity weakness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C3-C4 epidural abscess&#44; vertebral bodies destruction and dyscitis&#46; Eikenella corrodens&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Debridement with discectomy&#44; iliac crest graft and posterior cervical fusion&#46;6 weeks of intravenous antibiotic therapy&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70sMale&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tongue base cancerRadiation&#44; recurrent laryngeal cancer treated with laryngectomy&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Incidental finding on PET-CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C5-C6 Cervical spine spondylodiscitis&#46; Pseudomona aeruginosa&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Debridement with discectomy&#44; iliac crest graft and posterior cervical fusion&#46;6 weeks of intravenous antibiotic therapy&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3715531.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Reported cases of cervical spondylodyscitis or epidural abscess related to esophageal dilations&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:15 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cervical spondylodiscitis after esophageal dilation in patients with a history of laryngectomy or pharyngectomy and pharyngeal irradiation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; D&#8217;Souza"
                            1 => "J&#46; Luginbuhl"
                            2 => "R&#46; Goldman"
                            3 => "E&#46; Joshua"
                            4 => "J&#46; Curry"
                            5 => "D&#46; Cognetti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jamaoto.2015.3038"
                      "Revista" => array:7 [
                        "tituloSerie" => "JAMA Otolaryngol Head Neck Surg"
                        "fecha" => "2016"
                        "volumen" => "142"
                        "numero" => "5"
                        "paginaInicial" => "467"
                        "paginaFinal" => "471"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27010455"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spinal epidural abscess after cervical pharyngoesophageal dilation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "D&#46; Ekbom"
                            1 => "J&#46; D-Elia"
                            2 => "B&#46; Isaacson"
                            3 => "F&#46; LaMarca"
                            4 => "D&#46; Chepeha"
                            5 => "C&#46; Bradford"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Head Neck"
                        "fecha" => "2005"
                        "volumen" => "27"
                        "paginaInicial" => "543"
                        "paginaFinal" => "548"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Proximal esophageal stenosis in head and neck cancer patients after total laryngectomy and radiation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;N&#46; Vu"
                            1 => "T&#46;A&#46; Day"
                            2 => "M&#46;B&#46; Gillespie"
                            3 => "B&#46; Martin-Harris"
                            4 => "D&#46; Sinha"
                            5 => "R&#46;K&#46; Stuart"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000130870"
                      "Revista" => array:7 [
                        "tituloSerie" => "ORL J Otorhinolaryngol Relat Spec"
                        "fecha" => "2008"
                        "volumen" => "70"
                        "numero" => "4"
                        "paginaInicial" => "229"
                        "paginaFinal" => "235"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18467817"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cervical epidural abscess and vertebral osteomyelitis following non-traumatic oesophageal rupture&#58; a case report and discussion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46; Metcalfe"
                            1 => "C&#46; Morgan-Hough"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00586-009-0889-9"
                      "Revista" => array:7 [
                        "tituloSerie" => "Eur Spine J"
                        "fecha" => "2009"
                        "volumen" => "18"
                        "numero" => "Suppl 2"
                        "paginaInicial" => "224"
                        "paginaFinal" => "227"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19184129"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cervical osteomyelitis after placement of a self-expanding plastic stent for palliation of dysphagia associated with chemoradiation-induced esophageal structures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46; Mullen"
                            1 => "A&#46; Sharma"
                            2 => "A&#46; Vamma"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/hed.22975"
                      "Revista" => array:7 [
                        "tituloSerie" => "Head Neck"
                        "fecha" => "2013"
                        "volumen" => "35"
                        "numero" => "6"
                        "paginaInicial" => "E197"
                        "paginaFinal" => "201"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22367919"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cervical Spondylodiscitis associated with esophageal perforation&#58; a rare complication after anterior cervical fusion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46; Korovessis"
                            1 => "T&#46; Repantis"
                            2 => "V&#46; Vistas"
                            3 => "K&#46; Vardakastanis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00590-012-1092-y"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Orthop Surg Traumatol"
                        "fecha" => "2013"
                        "volumen" => "23 Suppl 2"
                        "paginaInicial" => "S159"
                        "paginaFinal" => "63"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23412223"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Upper cervical spine infection&#46; Complication of hypopharyngeal injury"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46; Skaf"
                            1 => "E&#46; Elias"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4236/ijohns.2016.52016"
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Otorhinolaryngol Head Neck Surg"
                        "fecha" => "2016"
                        "volumen" => "05"
                        "paginaInicial" => "96"
                        "paginaFinal" => "102"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spinal epidural abscess presenting with paraplegia following delayed presentation of traumatic esophageal perforation without spinal fracture&#58; lessons to be learnt"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46;D&#46; Baron"
                            1 => "D&#46; Pal"
                            2 => "D&#46;W&#46; Crimmins"
                            3 => "S&#46;P&#46; Dexter"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00068-009-8225-y"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Trauma Emerg Surg"
                        "fecha" => "2010"
                        "volumen" => "36"
                        "paginaInicial" => "247"
                        "paginaFinal" => "249"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26815868"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Infectious spondylodiscitis caused by esophageal injury after blunt chest trauma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;Y&#46; Park"
                            1 => "H&#46;K&#46; Chung"
                            2 => "K&#46;W&#46; Yoon"
                            3 => "S&#46;I&#46; Jung"
                            4 => "C&#46;H&#46; Park"
                            5 => "Y&#46;E&#46; Joo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.gie.2010.02.025"
                      "Revista" => array:7 [
                        "tituloSerie" => "Gastrointest Endosc"
                        "fecha" => "2010"
                        "volumen" => "72"
                        "numero" => "5"
                        "paginaInicial" => "1095"
                        "paginaFinal" => "1097"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20541194"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Esophageal perforation complicating with spinal epidural abscess&#44; iatrogenic or secondary to first thoracic spine fracture&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "H&#46;C&#46; Chen"
                            1 => "W&#46;C&#46; Tzaan"
                            2 => "T&#46;Y&#46; Chen"
                            3 => "P&#46;H&#46; Tu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00701-004-0305-5"
                      "Revista" => array:7 [
                        "tituloSerie" => "Acta Neurochir &#40;Wien&#41;"
                        "fecha" => "2005"
                        "volumen" => "147"
                        "paginaInicial" => "431"
                        "paginaFinal" => "434"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15785966"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0092867423000053"
                          "estado" => "S300"
                          "issn" => "00928674"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#40;2016&#41; Cervical spondylodiscitis following an invasive procedure on the neopharynx after circumferential pharyngolaryngectomy&#58; a retrospective case series"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Espitalier"
                            1 => "A&#46; Keating-Hart"
                            2 => "S&#46; Morini&#232;re"
                            3 => "J&#46;M&#46; Badet"
                            4 => "N&#46; Asseray"
                            5 => "C&#46; Ferron"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00586-016-4741-8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Spine J"
                        "fecha" => "2016"
                        "volumen" => "25"
                        "paginaInicial" => "3894"
                        "paginaFinal" => "3901"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27566300"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cervical spinal epidural abscess after esophagoscopy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46; Radulovic"
                            1 => "L&#46; Vujotic"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00586-012-2478-6"
                      "Revista" => array:7 [
                        "tituloSerie" => "Eur Spine J"
                        "fecha" => "2013"
                        "volumen" => "22"
                        "numero" => "3"
                        "paginaInicial" => "S369"
                        "paginaFinal" => "S372"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22918512"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A rare complication of esophageal stent&#58; spinal epidural abscess"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46;Y&#46; Li"
                            1 => "W&#46;C&#46; Chen"
                            2 => "S&#46;S&#46; Yang"
                            3 => "Y&#46; Lee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2009.02.079"
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2009"
                        "volumen" => "88"
                        "numero" => "5"
                        "paginaInicial" => "1700"
                        "paginaFinal" => "1702"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19853149"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Latent spinal epidural abscess revealed 4 months after esophageal perforation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "E&#46; Condrea"
                            1 => "D&#46; Lisii"
                            2 => "V&#46; Timirgaz"
                            3 => "I&#46; Codreanu"
                            4 => "N&#46; Rotaru"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.spinee.2014.07.012"
                      "Revista" => array:7 [
                        "tituloSerie" => "Spine J"
                        "fecha" => "2014"
                        "volumen" => "14"
                        "numero" => "12"
                        "paginaInicial" => "3054"
                        "paginaFinal" => "3055"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25088959"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Successful conservative management of delayed cervical spondylodiscitis with epidural abscess caused by esophageal diverticulitis&#58; a case report and review of literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Ying"
                            1 => "S&#46; Pei"
                            2 => "L&#46; Su"
                            3 => "T&#46; Wen"
                            4 => "Y&#46; Lv"
                            5 => "D&#46; Ruan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.wneu.2018.05.207"
                      "Revista" => array:6 [
                        "tituloSerie" => "World Neurosurg"
                        "fecha" => "2018"
                        "volumen" => "118"
                        "paginaInicial" => "250"
                        "paginaFinal" => "260"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29883818"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/11301473/0000003500000006/v1_202411050451/S1130147324000897/v1_202411050451/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/11301473/0000003500000006/v1_202411050451/S1130147324000897/v1_202411050451/en/main.pdf?idApp=UINPBA00004B&text.app=https://revistaneurocirugia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147324000897?idApp=UINPBA00004B"
]
Información del artículo
ISSN: 11301473
Idioma original: Inglés
Datos actualizados diariamente
año/Mes Html Pdf Total
2024 Noviembre 10 0 10

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?