Complete Osteolysis of the Dens With Atlantoaxial Luxation Caused by Infection With Staphylococcus Aureus

Abstract

To our knowledge, this presents the first reported case of a complete destruction of the dens, as a result of a purulent bacterial infection leading to atlantoaxial luxation. Our case demonstrates that infections of the atlantoaxial region are difficult to diagnose and are seen mostly in immunocompromised patients, such as patients with diabetes. Furthermore, it proves that other infections besides tuberculosis can lead to complete osteolytic destruction of the atlantoaxial joint.

Septic Arthritis of the Atlantoaxial Joint

“…3,9,12,18,19 The most common risk factors for hematogeneous pyogenic facet joint infection are recent or concurrent extraspinal infection and diabetes mellitus. 15,16 Theoretically, the zygapophysial joint is seeded during the bacteremic phase of a concurrent or recent infection.…”

“…1 Isolated involvement of the atlantoaxial segment has rarely been documented in the English literature. [2][3][4][5][6][7][8][9][10][11][12]13,18,19 In all cases, the odontoid processes were mainly affected with osteomyelitis and in some patients subsequent dislocation of the atlantoaxial joint 3,12 or formation of epidural abscess with progressive neurologic deficits was noted. 10,13,20 Furthermore, septic arthritis of the facet joints is also an uncommon clinical entity.…”

“…Most epidural abscesses in the upper cervical spine are accompanied by osteomyelitis confined to the odontoid process. [2][3][4][5][6][7][8][9][10][11][12][13] Therefore, epidural abscess after septic arthritis of the atlantoaxial joint has the least common incidence. Septic arthritis of the facet joint itself is an uncommon clinical entity, and most reported cases have been in the lumbar region.…”

Abscess of C1/C2 cervical vertebrae - errors in diagnosis and therapy

“…The proper diagnosis of the disease was delayed for more than a year. Busche et al 7 described a young man with diabetes and similar symptoms in the upper cervical spine of six months' duration before a sudden change for the worse and a proper diagnosis was made. Noguchi et al 8 described the case of an elderly patient who complained of neck pain and stiffness of 7 days' duration and had symptoms of meningeal irritation.…”

“…the upper cervical spine inflammation were described by Busche et al 7 Her diagnosis was "the neck pain syndrome", which was treated with the physical therapy for several months. The proper diagnosis of the disease was delayed for more than a year.…”