Cranial and Vertebral Osteomyelitis — WACS Viva & Clinical Scenarios (Central Nervous System Infections and Infestations)

Exam-style cranial and vertebral osteomyelitis viva scenarios with examiner probes and model answers for Neurosurgery candidates.

Scenarios covered

• SCENARIO 1: Clinical and Radiological Differentiation of Pyogenic Spondylodiscitis versus Tuberculous Spondylitis: A 58-year-old diabetic male presents with a 4-week history of worsening axial lumbar back pain, low-grade fevers, elevated erythrocyte sedimentation rate (ESR 88 mm/hr), and C-reactive protein (CRP 64 mg/L). Contrast-enhanced lumbar MRI demonstrates L4-L5 intervertebral disc collapse, destruction of adjacent endplates, and a ventral epidural phlegmon. Detail your diagnostic protocol, image-guided biopsy indications, and the key pathological and imaging distinctions between pyogenic and tuberc
• SCENARIO 2: Emergency Surgical Decision-Making in Cervical Spondylodiscitis with Spinal Epidural Abscess: A 46-year-old female presents with severe suboccipital and mid-cervical pain, high-grade fevers, progressive tetraparesis (power grade 3/5 in all four limbs), and urinary retention. MRI reveals C5-C6 pyogenic discitis, severe vertebral body osteomyelitis with kyphotic collapse, and a substantial anterior epidural abscess causing severe canal stenosis and spinal cord compression. Outline your immediate resuscitative measures, operative strategy, approach selection, stabilization principles, and postope
• SCENARIO 3: Diagnosis and Surgical-Medical Management of Skull Base Osteomyelitis: A 64-year-old uncontrolled diabetic man presents with deep otalgia, purulent otorrhea, left-sided lower motor neuron facial palsy, and hoarseness with dysphagia. High-resolution CT shows erosion of the external auditory canal, petrous apex, and clivus, while MRI confirms inflammatory obliteration of the fat within the jugular foramen and infratemporal fossa. Describe the pathophysiological progression from malignant otitis externa to cranial neuropathy, diagnostic nuclear imaging modalities, tissue isolation protocols, and
• SCENARIO 4: Management of Pott Puffy Tumour with Extradural Extension: A 17-year-old male with a 2-week history of untreated frontal sinusitis presents with a soft, fluctuant, non-pulsatile, tender forehead swelling, periorbital oedema, high fevers, and increasing lethargy. CT of the head reveals opacification of the frontal sinuses, erosion of the anterior and posterior tables of the frontal bone, and an associated extradural collection. Detail the surgical exposures, debridement protocols, handling of the sinus mucosa, and empirical and targeted antimicrobial strategies.
• SCENARIO 5: Protocol for Post-Craniotomy Bone Flap Osteitis and Staged Cranioplasty: A 42-year-old male who underwent an elective pterional craniotomy for aneurysm clipping 6 weeks ago presents with surgical wound breakdown, purulent drainage, and local scalp tenderness. Cranial CT demonstrates osteolysis of the bone flap margins and an underlying subgaleal and extradural inflammatory collection. Detail the step-by-step neurosurgical debridement protocol, criteria for bone flap sacrifice versus salvage, intraoperative microbiological workup, antimicrobial duration, and specific conditions required prior t