Case: A fifty-six-year-old man presented with a three-month history of worsening neck pain and weakness of the right arm. Magnetic resonance imaging revealed C5-C6 osteomyelitis and discitis and a prevertebral abscess from C3 to C7. He underwent staged instrumented anterior and posterior spinal fusion from C5 to C7, with an anterior C5-C6 cervical discectomy and a C6 corpectomy. Intraoperative cultures exhibited growth of Stenotrophomonas maltophilia. The patient subsequently received five months of oral trimethoprim/sulfamethoxazole therapy. At twelve months postoperatively, he had full recovery of motor strength bilaterally.
Conclusion: Osteomyelitis with S. maltophilia is associated with agricultural-machinery-related injuries. Surgical intervention for cervical osteomyelitis should be considered if the patient presents with a neurologic deficit or a paravertebral abscess.