Surgical treatment of delayed cervical infection and incomplete quadriplegia with fish-bone ingestion:A case report

BACKGROUND The most commonly ingested foreign body in Asians is fish bone.The vast majority of patients have obvious symptoms and can be timely diagnosed and treated.Cases of pyogenic cervical spondylitis and diskitis with retropharyngeal and epidural abscess resulting in incomplete quadriplegia due to foreign body ingestion have been rarely reported.The absence of pharyngeal or esophageal discomfort and negative computed tomography(CT)findings of fish bone have not been reported.We report the case of an elderly female patient with delayed cervical infection and incomplete quadriplegia who had a history of fish bone ingestion.CASE SUMMARY A 73-year-old woman presented with right neck pain and weakness of four limbs for a week,and had a history of fish bone ingestion and negative findings on laryngoscopic examination one month previously.She did not complain of any pharyngeal or esophageal discomfort.Cervical magnetic resonance imaging showed C4/C5 spondylitis and diskitis along with retropharyngeal and ventral epidural abscesses.No sign of fish bone was detected on lateral cervical radiography and CT scans.The muscle strength of the patient’s right lower limb receded to grade 1 and other limbs to grade 2 suddenly on the 10th day of hospitalization.Emergency surgery was performed to drain the abscess and decompress the spinal cord by removing the anterior inflammatory necrotic tissue.Simultaneously,flexible esophagogastroduodenoscopy was carried out and a hole in the posterior pharyngeal wall was found.The motor weakness of the right lower limb improved to grade 3 and the other limbs to grade 4 within 2 d postoperatively.CONCLUSION This rare case highlights the awareness of the posterior pharyngeal or esophageal wall perforation in patients with cervical pyogenic spondylitis along with a history of fish bone ingestion,even though local discomfort symptoms are absent and the radiological examinations are negative.

Study on Prevention and Treatment of Autophagy and Cervical HPV Infection by Traditional Chinese Medicine Based on Pathogenesis of "Syndrome of Dampness-heat Diffusing Downward"

Autophagy is a self-protection mechanism of the body,and also an important physiological process for cells to maintain internal environment stability.Studies have shown that the degree of autophagy damage is positively correlated with the expression of oncogenes,and the expression of oncogenes is closely related to cervical HPV infection,so the control of autophagy ability can interfere with cervical HPV virus infection.Traditional Chinese medicine believes that dampness-heat evil down,can damage and Chong Ren cell.The author believes that autophagy damage and the theory of dampness-heat injection in cervical HPV infection have similar pathogenic mechanism,and explores the prevention and treatment of autophagy and cervical HPV infection based on the theory of traditional Chinese medicine dampness-heat injection,in attempt to provide a new treatment for clinical prevention and treatment.