Atlanto-axial subluxation after pyogenic spondylitis of the atlanto-occipital joint

Abstract

This report presents a case of atlanto-axial subluxation after treatment of pyogenic spondylitis of the atlanto-occipital joint. A 60-year-old male had 1-month history of neck pain with fever. Magnetic resonance imaging showed inflammation around the odontoid process. Intravenous antibiotic therapy was administrated immediately. After 6 weeks, CRP had returned almost to normal. After 4 months, laboratory data was still normal, but the patient experienced increasing neck pain. Lateral cervical radiography in the neutral position showed instability between C1 and C2. Computed tomography showed a bony union of the atlanto-occipital joint and severe destruction of the atlanto-axial joint on the left side. Transarticular screw fixation for the atlanto-axial joint was performed. A lateral cervical radiograph in the neutral position after surgery showed a solid bony union. Neck pain improved following surgery. We speculate that spondylitis of the atlanto-occipital joint induced a loosening of the transverse ligament and articulation of the atlanto-axial joint. A bony fusion of the atlanto-occipital joint after antibiotic treatment resolved the pyogenic inflammation concentrated stress to the damaged atlanto-axial joint, resulting in further damage. The atlanto-axial instability was finally managed by the insertion of a transarticular screw.

Exploration for reliable radiographic assessment method for hinge-like hypermobility at atlanto-occipital joint

“…O-C1 instability can be also associated with rheumatoid arthritis (RA) [16,20] ankylosing spondylitis (AS) [8,22], Down syndrome [3,11,23] or infectious diseases [26], as mentioned. Future study using the radiographic method we proposed in the current study may also contribute to clarify the underlying mechanism of these diseases.…”

“…Non-traumatic O-C1 instability [3,8,14,16,20,22,23,26], which is less common, is usually associated with rheumatoid arthritis (RA) [16,20] or ankylosing spondylitis (AS) [8,22]. It can also be associated with Down syndrome [3,11,23] or infectious diseases [26].…”

Atlantoaxial Subluxation after Pyogenic Spondylitis around the Odontoid Process

“…The AAS is a well-known complication developing secondary to congenital disorders, anomalies, trauma, and connective tissue disorders such as rheumatoid arthritis. The AAS is a serious condition that can lead to quadriplegia and sudden death due to cervical cord compression [ 2 – 5 ]. Pyogenic spondylitis of the upper cervical spine is seen in only 1.7% of all pyogenic spondylitis cases [ 6 ].…”

“…Several previous studies have reported that for patients with an infection that cannot be controlled with aggressive intravenous antibiotics treatment or for those with neurological deficits who cannot be stabilized by external fixation, curettage or decompression should be performed [ 3 , 5 , 6 , 8 , 12 , 13 ]. In our case, the infection status and motor deficits both improved after the initial administration of antibiotics and halo vest fixation, and surgical intervention was not required.…”

Chronic infectious lesions of the cervical spine in adults: monocentric cohort analysis and literature review

“…Тактика хирургического лечения шейных спондилитов определяется распространенностью костной деструкции и особенностями клинической картины [9]. Наилучшие клинические результаты при субокципитальных спондилитах (Ос-С 2 ) обеспечивает окципитоспондилодез в сочетании с трансоральной санацией и декомпрессией [10][11][12], в то время как при субаксиальных (С 3 -С 7 ) поражениях эффективна изолированная передняя реконструкция -корпэктомия и спондилодез [13][14][15].…”