PMC9479651_01
Physical examination revealed pustulosis on the sole of feet (a) and acne on anterior chest (b).
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F1
On physical examination, she had evidence of the SAPHO syndrome characterized by synovitis, acne, pustulosis, hyperostosis, osteitis, palmoplantar pustulosis, and acne on anterior chest wall [Figures 1a and b].
Preoperative images. (a) Cervical plain radiography shows kyphotic deformity of C5-C7 vertebral bodies. (b) Sagittal CT scan demonstrates remarkable destructive change at C6 vertebra. (c and d) Midsagittal MRI of cervical spine shows highly tortuous spinal cord and compressed vertebrae of C5, 6 with T1 hypointense signal, T2 iso-hyperintense signal.
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F2
Plain cervical X-rays showed destruction of the C5-C7 vertebral bodies with kyphosis [Figure 2a]. The CT demonstrated C5-C7 lytic changes with marginal sclerosis, while the MR revealed spondylodiscitis with severe C5-C7 cord compression [Figures 2b-d].
18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET/CT) shows an abnormally high uptake of cervical spine (a), tonsils (b), and sternocostoclavicular joint (c).
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F3
Whole body 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET/CT) demonstrated increased uptake involving the sternocostoclavicular joint, tonsils, and C5-C7 vertebrae [Figures 3a-c].
Intraoperative microscopic views. Granulomatous tissue was observed at anterior part of C5,6 vertebrae.
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F4
Erosive granulomatous tissue was removed, but no abscess or solid tumor were encountered [Figure 4].
Postoperative images. (a) C5-C6 corpectomy and anterior fixation in the C4-C7 were performed, and posterior instrumentation was fitted from C2 to Th1. The alignment was well corrected. (b) The compression of cervical spinal cord improved.
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F5
Postoperatively, her quadriparesis immediately resolved and imaging studies demonstrated decompression of spinal cord with correction of the kyphosis [Figures 5a and b].