Deep Surgical Site Infection with Epidural Abscess Following Anterior Cervical Discectomy and Fusion: A Case Report and Incidence Analysis in Sweden

<b><i>Background:</i></b> Anterior cervical discectomy and fusion (ACDF) is a common spinal procedure with a low complication rate. Although dysphagia and recurrent laryngeal nerve paralysis are well-documented, deep surgical site infections (SSIs) are rare (0.03%-0.3%). This report presents a rare case of deep SSI with an epidural abscess post-ACDF and analyzes the incidence of SSI in Sweden using Swespine data. <b><i>Case Presentation:</i></b> A 55-year-old female developed cervicothoracic pain and bilateral arm pain three weeks after C6/7 ACDF. Imaging confirmed deep SSI with an epidural abscess. Despite antibiotic agents, reoperation was required 37 days post-operatively, involving C7 corpectomy and titanium reconstruction. Cultures identified oral flora, suggesting hematogenous spread from untreated dental caries. Swespine data showed a 0.05% incidence of deep SSI among 9,382 cases. <b><i>Conclusions:</i></b> Deep SSI following ACDF is an exceptionally rare but serious complication. Cervicothoracic pain may indicate SSI, and pre-operative dental care is advisable to reduce infection risk.