Late infection six years post cervical arthroplasty detected following referral to a 2 week-wait head and neck cancer clinic: a case report

Abstract

Late infection after anterior cervical spine surgery (ACSS) is a rare phenomenon and can be extremely challenging to diagnose. Clinical presentation vary and may not present with classical features of fever, pain, malaise or discharge. It can easily be mistaken for a head and neck tumour due to its ambiguous symptoms and signs. We report a case of a 57 years old lady whom was initially referred to the 2 week-wait (2 ww) head and neck cancer clinic. She complained of painless neck lump and dysphagia. She subsequently underwent various investigations including flexible nasendoscopy, ultrasound scan guided biopsy, eosophagogastroduodenoscopy (OGD), CT scan, PET-CT scan and MRI scan. Initial investigations failed to clinch the diagnosis. US and CT scans findings were suspicious for malignancy. All blood results were in normal ranges. It was only after PET-CT scan was done that the diagnosis pathway switched from possible malignancy to purely inflammatory. It showed significant high activity process tracking back to the 6 years old spinal surgery area. This precluded the patient from a planned open biopsy. Radiological imaging such as PET-CT and MRI are essential in both diagnosis and treatment planning.