Cervical osteomyelitis in the setting of multiple comorbidities: a complex anatomical approach. Illustrative case.

backgroundVertebral osteomyelitis (VO), also known as spinal osteomyelitis or spondylodiscitis, is a rather rare yet serious disease comprising 3%-5% of all osteomyelitis cases, with only 3%-6% of this subset affecting the cervical spine. Risk factors include an advanced age, diabetes, immunosuppression, and intravenous (IV) drug use. The incidence of VO has increased over recent decades, with high-risk patients experiencing higher mortality rates. Treatment guidelines for VO are not standardized and rely on physician preference, often starting with IV antibiotics and progressing to surgery, if necessary. OBSERVATIONS: A 54-year-old female with tracheostomy-dependent obesity hypoventilation syndrome, hypertension, and morbid obesity presented with upper back pain after a fall. Imaging revealed early C6-7 discitis osteomyelitis, which was initially managed conservatively with IV antibiotics. Her condition worsened, leading to anterior corpectomy of C6-7, followed by posterior cervical fusion from C5 to T2 in the sitting position. This approach was chosen due to the patient's complex anatomy and tracheostomy. LESSONS: This case underscores the need for unique surgical approaches in high-risk patients with complex anatomy. It highlights the importance of interdisciplinary care when managing VO, especially in patients with multiple comorbidities. Given the increasing rates of morbid obesity, this case provides valuable insights for neurosurgical decision-making in similar future cases. https://thejns.org/doi/10.3171/CASE24448.