Demographic and clinical summary of presented cases of proximal junctional spondylodiscitis.
| Case 1 | Case 2 | Case 3 | |
| Age, y | 58 | 68 | 76 |
| Gender | Female | Male | Female |
| Comorbidities | Anemia, scoliosis | Anterior cervical discectomy and fusion, asthma, hypertension | Chronic obstructive pulmonary disease, rheumatoid arthritis, PE, chronic deep vein thrombosis |
| Index operation | ALIF L3-L4, L4-L5, L5-S1 T4-pelvis PSIF, PCOs T6-S1, posterior ligamentous repair T3-T5 | ALIF L4-L5, L5-S1 T10-pelvis, PCOs T12-S1, vertebroplasty of T9 and T10, posterior ligamentous repair T9-T11 | T11-L5 PSIF and ALIF L5-S1 (performed at outside hospital) |
| Presenting symptoms | Significant back pain, difficulty with ambulation, bowel/bladder incontinence | Back pain | T10 sensory level, bilateral lower extremity weakness, severe back pain |
| Preoperative infectious laboratory findings | None | WBC 7.6, platelets 538, erythrocyte sedimentation rate 46, CRP 14.7 | WBC 13.5, CRP 71.4 |
| Proximal junctional pathology | Instrumentation pullout proximal junction; increased T2 signal in proximal junctional disc (T3-T4) | Pathologic fracture at UIV +1, epidural abscess | Pathologic fractures at upper instrumented vertebra, UIV +1, incomplete spinal cord injury |
| Time to infection/proximal junctional failure | 3 mo | 2 y | 6 mo |
| Microbiology | Staphyloccocus aureus | No growth | Methicillin-resistant S aureus |
Abbreviations: ALIF, anterior lumbar interbody fusion; CRP, C-reactive protein; PCO, posterior column osteotomy; PE, pulmonary embolism; PJS, proximal junctional spondylodiscitis; PSIF, posterior spinal instrumentation and fusion; UIV +1, unfused adjacent segment; UIV, upper instrumented vertebra; WBC, white blood cell count.