Concomitant Fungal and Bacterial Atlanto-Axial Osteomyelitis: A Case Report

Yau, Edmund Leung-kai; Li, Ka Kin

doi:10.1177/230949901001800221

Cited by 6 publications

(3 citation statements)

References 8 publications

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“…Transoral decompression has been the “gold standard” procedure for anterior decompression of C1 and C2, however, there may be disadvantages to this approach, specifically in the setting of acute osteomyelitis, and immunocompromised with poor baseline health. 1 2 3 4 5 6 7 8 9 These include a long surgical corridor with limited visualization, and limited manual/digital access beyond the oral cavity given dental, occlusal, and palatal anatomic constraints. Following a transoral approach, there is exposure of the surgical bed to saliva and oral contents with each swallow raising concern for impaired healing or infection, especially in the event of CSF leakage.…”

Section: Discussionmentioning

confidence: 99%

“…Pyogenic osteomyelitis of the craniocervical junction is a rare event that has been infrequently described in the literature. 1 2 3 4 5 6 7 8 9 The clinical manifestations most often include neck pain, stiffness, swelling, and dysphagia, although this entity may also present with meningitis. Most commonly afflicted are elderly or immunocompromised patients harboring comorbidities such as diabetes or end-stage renal disease.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic Transnasal Approach for Urgent Decompression of the Craniocervical Junction in Acute Skull Base Osteomyelitis

et al. 2015

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Ventral epidural abscess with osteomyelitis at the craniocervical junction is a rare occurrence that typically mandates spinal cord decompression via a transoral approach. However, given the potential for morbidity with transoral surgery, especially in the setting of immunosuppression, together with the advent of extended endonasal techniques, the transnasal approach could be attractive for selected patients. We present two cases of ventral epidural abscess and osteomyelitis at the craniocervical junction involving C1/C2 that were successfully treated via the endoscopic transnasal approach. Both were treated in staged procedures involving posterior cervical fusion followed by endoscopic transnasal resection of the ventral C1 arch and odontoid process for decompression of the ventral spinal cord and medulla. Dural repairs were successfully performed using multilayered, onlay techniques where required. Both patients tolerated surgery exceedingly well, had brief postoperative hospital stays, and recovered uneventfully to their neurologic baselines. Postoperative magnetic resonance imaging confirmed complete decompression of the foramen magnum and upper C-spine. These cases illustrate the advantages and low morbidity of the endonasal endoscopic approach to the craniocervical junction in the setting of frank skull base infection and immunosuppression, representing to our knowledge a unique application of this technique to osteomyelitis and epidural abscess at the craniocervical junction.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Endoscopic Transnasal Approach for Urgent Decompression of the Craniocervical Junction in Acute Skull Base Osteomyelitis

et al. 2015

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“…While in nonimmunocompromised patients, spondylodiscitis caused by fungal infections is often diagnosed late (12). The most common reason for fungal infections is Candida and rarely Aspergillus.…”

Section: Discussionmentioning

confidence: 99%

Concurrence of polyostotic fibrous dysplasia and spinal aspergillus in non-immunocompromised adult patient:case report

Paşahan¹,

Durak²,

Aladağ³

et al. 2017

J Turgut Ozal Med Cent

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Aspergillus, a rare agent in spinal infections, is often transmitted via inhalation. It can be traced as an infectious agent in immunocompromised patients. While in non-immunocompromised patients, it is highly unlikely to cause spondylodiscitis. Radiological findings remind tuberculosis. The recommended medical treatment is applied with Itraconazole and Amphotericin B. Surgical indication involves the presence of progressive neurological deficit, instability and biopsy requirement. Fibrous dysplasia was first reported in 1938 by Lichtenstein and is a benign developmental disorder of the skeletal system with uncertain etiology. Polyostotic type involved more than one bone, while the monostotic type occurs by involving only one bone structure. Spinal involvement may lead to collapse fractures and deformity development and the most common complaint is pain. In our case, these two disorders occur concurrently, causing bone destruction and severe pain, and no similar cases were found in the literature.

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