Disclosures: Jason Lew, DO: No financial relationships or conflicts of interest

Case Diagnosis: Non-traumatic spinal cord injury secondary to scalene abscess with esophageal fistula leading to cervical epidural abscess in a patient with laryngeal cancer.

Case Description: 67-year-old male with history of laryngeal cancer status post radiation complicated by chondronecrosis of larynx, prostate and penile cancer, who presented with left sided weakness and hypoxia. He then underwent cardiac arrest. After stabilization, patient developed aspiration pneumonia and bacteremia. A scalene abscess was found and drained. Due to severe dysphagia, he had a G-tube placed. He was discharged to an acute inpatient rehabilitation hospital where interval CT scan showed osteomyelitis and epidural abscess at C5-C6. He returned to acute care hospital, but drainage was limited due to post-radiation changes. He had a non-functional larynx and underwent tracheostomy. Due to the high risk for complications of total laryngectomy and pharyngectomy, he was recommended conservative treatment with long term IV antibiotics. He discharged to acute inpatient rehabilitation a second time. There, he was found to have an esophageal fistula tracking to his right scalene on video swallow study.

Setting: Acute inpatient rehabilitationAssessment/

Results: Functional improvement

Discussion: This patient’s history of extensive cancer placed him at significantly higher risk for poor healing and return to prior level of function. With acute rehabilitation, he was able to receive collaborative care from multiple medical specialties and rehabilitation services. Inpatient rehabilitation was critical in treating physical complications following cancer in a new non-traumatic SCI, as well as new psychological barriers such as inability to speak or eat. He progressed from requiring max assist with functional measures to supervision.

Conclusion: A scalene abscess with esophageal fistula is an uncommon cause of non-traumatic spinal cord injury. This case highlights a multi-faceted approach in acute rehabilitation for a new SCI patient with multiple oncological complications. This allowed for significant neurological and musculoskeletal recovery for maximal gains towards the patient’s functional goals.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/non-traumatic-spinal-cord-injury-secondary-to-scalene-abscess-with-esophageal-fistula-a-case-report/