Spinal Infections and Spondylodiscitis — WACS Viva & Clinical Scenarios (Spinal Neurosurgery and Spinal Cord Disorders)

Exam-style spinal infections and spondylodiscitis viva scenarios with examiner probes and model answers for Neurosurgery candidates.

Scenarios covered

• SCENARIO 1: A 34-year-old man presents with progressive mid-thoracic back pain, low-grade evening pyrexia, night sweats, and a 3-week history of worsening spastic paraparesis with hyperreflexia and bilateral extensor plantar responses. Contrast-enhanced MRI reveals destruction of T7 and T8 vertebral bodies with relative preservation of the T7-T8 intervertebral disc, subligamentous spread beneath the anterior longitudinal ligament, a large prevertebral cold abscess, and posterior epidural compression causing cord compromise. What is the most definitive diagnostic protocol and immediate clinical management
• SCENARIO 2: A 48-year-old woman with poorly controlled type 2 diabetes mellitus presents to the emergency department with severe, focal lumbar back pain of 4 days' duration, high-grade fever, radicular pain down the L5 dermatome, and acute progressive foot drop. Gadolinium-enhanced MRI confirms an acute dorsal spinal epidural abscess extending from L3 to S1. Outline your emergency diagnostic and surgical triage, surgical approach, intraoperative microbiological handling, and targeted antimicrobial strategy.
• SCENARIO 3: A 19-year-old male with homozygous sickle cell disease (HbSS) presents with severe lower thoracic back pain, elevated inflammatory markers (ESR 110 mm/hr, CRP 85 mg/L), and an MRI showing confluent T1 hypointensity, T2 hyperintensity crossing the T11-T12 intervertebral disc into adjacent endplates, and contiguous paraspinal phlegmon. Detail the differential diagnosis, percutaneous diagnostic biopsy technique, empirical and culture-directed antibiotic selection, and perioperative sickle cell optimization protocols.
• SCENARIO 4: Distinguish between the radiological, pathological, and clinical profiles of tuberculous spondylitis (Pott disease), pyogenic spondylodiscitis, and brucellar spondylitis. Detail the absolute and relative indications for surgical stabilization and anterior versus posterior decompression in advanced Pott paraplegia.
• SCENARIO 5: A 52-year-old man who underwent posterior lumbar decompression and instrumented fusion (L4-S1) 3 weeks ago presents with intractable surgical site pain, persistent wound drainage, elevated inflammatory markers, and systemic pyrexia. Detail the stepwise diagnostic workup, decision-making regarding implant retention versus removal, operative debridement protocol, biofilm management, and antimicrobial therapy duration.