The patient was operated by me 09-February-2022 for extruded disc C5-6. The patient after dramatic improvement for 3 days progressed sudden onset massive reaction to the construct with rapid deterioration of his neurological status. Suspicion about autoimmune disorder was was suspected, but he was admitted to KHMC for 20 days and he was covered by antibiotics without improvement.

On examination, the patient is still unable to walk, with no neck pain with preserved power of the biceps brachii and grip both hands. There is weak extension both hands 3/5 and the right triceps muscle 3/5. There is hypalgesia of the left L1 and L2 territories and both feet up to the ankle joint. The power of distal muscles both legs  and both quadriceps muscles 5/5, but weak right iliopsoas muscle 2/5 and left 4/5. There is brisk clonus and bilateral Babinski.

The patient was sent for investigations and dynamic studies of the cervical spine ruled out overmobility and CT-scan showed acceptable position of the construct. Lab investigations done and ESR was 95 mm/h and CRP was 11 mg/dL.

The old wound refreshed and exposure of the construct was achieved. There was a massive inflammatory reaction over the construct, which was in place. It was necessary to unlock the PEEK to remove it. The PEEK and the putty were removed in one piece and sent for lab investigations. All the reactive tissues were removed. Using Cloward instrumentation, an iliac bone graft 12 mm cylinder was achieved from the right. A hole with same diameter and depth of the graft was created to be more medial to the position of the PEEK cavity and to violate the lower border of C5. The bone graft was inserted and pushed with impacter. Using one level miniplate 28 mm length bended to accept the curve with 18 mm, 4 mm diameter, 4 screws applied to C5 and C6 was achieved to fuse the area. All stages of surgery were guided with C-arm. Smooth postoperative recovery with slight improvement of the upper limbs and right iliopsoas muscle. He was sent to the ward.

At the evening of the performed surgery, the patient showed dramatic improvement, that he could walk alone and the neurological deficit rapidly disappeared.

The patient is in discharge 26-May-2022.

The case is rare, that severe rejection of the putty and reactivation of the whole body inflammatory process and the previous malacia of the spine with clinical deterioration.

It was wise to remove the source of reactionary elements to ease his recovery.

It could be that the patient has unknown autoimmune disease, that causing such severe reaction and rejection to either the putty, or the PEEK or both.

Trying to know the brand of putty was impossible, because the company provider escaped. To my knowledge it was made in France.

It seems that the putty was the cause of inflammatory process and the reaction material was causing local regional arterial spasm. After cleaning of the area, these substances disappeared and the vasogenic constrictors disappeared and the patient regained such rapid recovery.