Spondylodiscitis, epidural abscess, and meningitis after transoral robotic surgical resection of a squamous cell carcinoma of the posterior pharyngeal wall

Abstract

Transoral robotic surgery (TORS) is a minimally invasive technique for resection of tumors of the posterior pharyngeal wall. Rarely, post-TORS cervical spondylodiscitis has been reported in the literature, with high morbidity and mortality. A 64-year-old female with underlying cervical disk disease underwent TORS resection of a posterior pharyngeal wall carcinoma without reconstruction in April 2020. Roughly one month post-operatively, the patient presented with clinical and radiographic signs of spondylodiscitis, epidural abscess, and meningitis. The patient was treated with antibiotic therapy and anterior cervical discectomy and fusion. The patient recovered without neurologic deficit. A three-month post-treatment PET-CT scan showed no evidence of residual disease. Post-operative cervical spondylodiscitis and meningitis are rare complications of TORS resection for posterior pharyngeal wall carcinomas, but the risk is increased in patients with underlying cervical disk disease. In such patients, perioperative antibiotic treatment and/or reconstruction should be considered to prevent neurologic complications and death.

Keywords

• Transoral robotic surgery
• Posterior pharyngeal wall carcinoma
• Spondylodiscitis
• Meningitis
• Surgical complication