Treatment of Primary Cervical Spine Infections: A Single-Center Analysis of the Management of 59 Patients over Three Decades

<b>Background:</b> Primary cervical spine infection is a rare but rapidly progressive disease that can cause early neurological damage, leading to increased morbidity and mortality. Despite its rising incidence, optimal treatment remains controversial. This study compared clinical, hematological, microbiological, and radiological outcomes among such patients treated with different methods. <b>Methods:</b> This retrospective comparative study is a secondary analysis of a previously reported cohort of 59 patients with primary cervical spine infection between 1992 and 2018 at a single institution. Patients were stratified into conservative (Group C, <i>n</i> = 14), surgery with instrumentation (Group S + I, <i>n</i> = 32), and surgery without instrumentation (Group S, <i>n</i> = 13) groups. Outcome measures included neurological status, antibiotic duration, hematological markers, radiological parameters (segmental angle, C2-C7 angle, segmental height, fusion rate), and complications. <b>Results:</b> The mean age and follow-up period were 61.4 years and 19.4 months, respectively. Group S + I demonstrated significantly better neurological outcomes at the last follow-up (<i>p</i> = 0.047) and shorter antibiotic treatment duration (<i>p</i> < 0.001). Radiological outcomes were superior in Group S + I, with greater improvements in segmental angle (<i>p</i> < 0.001), C2-C7 angle (<i>p</i> < 0.001), mean segmental height (<i>p</i> < 0.001), and fusion rate (84.4% vs. 14.3% and 46.2% in Group C and Group S, respectively; <i>p</i> < 0.001). Group S had significantly higher complication (46.2%, <i>p</i> = 0.011) and mortality (30.8%, <i>p</i> = 0.001). Hematological and microbiological results were not significantly different among groups. <b>Conclusions:</b> Surgical debridement with anterior instrumentation provided superior outcomes compared with conservative treatment or surgery without instrumentation. Early surgery with appropriate stabilization should be considered to optimize prognosis and minimize complications.