Cervical myelopathy caused by vertebral osteomyelitis after below-knee amputation for diabetic foot: A case report on early diagnosis and rehabilitation

Vertebral osteomyelitis (VO) usually results from hematogenous spread, while diabetic foot osteomyelitis (OM) spreads contiguously. Vertebral OM secondary to diabetic foot OM is rare. Herein, we reported a rare case of a 62-year-old male with multiple comorbidities, including diabetes mellitus, end-stage renal disease, and cardiovascular disease, who developed cervical VO four months after undergoing below-knee amputation due to diabetic foot OM. The patient presented with neck pain, progressive limb weakness, and respiratory insufficiency. Imaging confirmed cervical spondylodiscitis with compressive myelopathy. Due to a high Charlson Comorbidity Index score of 9 and poor general condition, surgical intervention was contraindicated. Conservative treatment, including intravenous antibiotics, cervical orthosis, and comprehensive rehabilitation, was initiated. Although the patient’s condition initially deteriorated to American Spinal Injury Association Impairment Scale Grade A, he showed gradual neurological improvement to Grade D with a neurological level of C6 after one year of continuous rehabilitation. This case highlights the need to consider VO as a potential complication in patients with high-risk diabetic foot OM and suggests that early conservative management combined with structured rehabilitation can lead to favorable neurological outcomes, even in patients with severe comorbidities.