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

Jiyon Bok ¹ ,Jee Hyun Suh ²

¹ Department of Rehabilitation Medicine, Ewha Womens University, College of Medicine, Seoul, Korea
² Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea DOI : 10.5606/tftrd.2026.16787 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. Keywords : Charlson Comorbidity Index, diabetic foot, nonsurgical treatment, rehabilitation, vertebral osteomyelitis