Pyogenic Osteomyelitis of the Atlas

Ueda, Yasuhiro; Kawahara, Norio; Murakami, Hideki; Matsui, Takashi; Tomita, Katsuro

doi:10.1097/brs.0b013e318198c805

Cited by 13 publications

(5 citation statements)

References 14 publications

(11 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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%

See 1 more Smart Citation

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

et al. 2015

View full text Add to dashboard Cite

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.

show abstract

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

View full text Add to dashboard Cite

show abstract

“…Ueda et al reported that an accurate diagnosis is the most important step, and that antibiotic treatment should be administered if the infection is in the early stages. If the patient is resistant to antibiotic treatment, or if neurological de cits, subluxation, or malalignment occur, then surgical treatment should be performed [13]. Our patient's treatment was delayed by 5 months because of misdiagnosis.…”

Section: Discussionmentioning

confidence: 98%

Vertical subluxation caused by infection around the odontoid process: a case report

Sanada

Tanaka

Shiokawa

et al. 2022

Preprint

View full text Add to dashboard Cite

Background: There are few reports of cases with vertical subluxation. We report our experience of a vertical subluxation of the atlantoaxial joint caused by infection. Case presentation: A 63-year-old man had a 5-month history of neck pain. He was treated for rheumatoid arthritis by a local doctor. At admission to our hospital, he had neck pain and complained of dysphagia and hoarseness. His white blood cell count and C-reactive protein were 7200/mm3 and 4.86 mg/dL. Cervical X-ray showed atlantoaxial subluxation. Computed tomography showed osteolysis around the odontoid process, including the atlantooccipital and atlantoaxial joints, causing vertical subluxation. Magnetic resonance imaging showed spinal cord and brainstem compression and the presence of fluid. Gadolinium-enhanced magnetic resonance imaging showed enhancement around the odontoid process. We performed occipital-cervical spine fixation and C1 laminectomy. Following surgery, his symptoms completely resolved. Bone fusion was confirmed 6 months after surgery. Conclusion: If subluxation of the upper cervical spine occurs rapidly, infection should be considered.

show abstract

“…Ueda et al reported that an accurate diagnosis is the most important step and that antibiotic treatment should be administered if the infection is in the early stages. If the patient is resistant to antibiotic treatment, or if neurological deficits, subluxation, or malalignment occur, then surgical treatment should be performed [ 16 ]. Our patient’s treatment was delayed by 5 months because of misdiagnosis.…”

Section: Discussionmentioning

confidence: 99%

Vertical Subluxation Caused by Infection Around the Odontoid Process: A Case Report

Sanada,

Tanaka,

Yamamoto

2024

jocr

View full text Add to dashboard Cite

Introduction: There are few reports of cases with vertical subluxation. We report our experience of a vertical subluxation of the atlantoaxial joint caused by infection. Case Report: A 63-year-old man had a 5-month history of neck pain. He was treated for rheumatoid arthritis by a local doctor. At admission to our hospital, he had neck pain and complained of dysphagia and hoarseness. His white blood cell count and C-reactive protein were 7200/mm3 and 4.86 mg/dL. Cervical X-ray showed atlantoaxial subluxation. Computed tomography showed osteolysis around the odontoid process, including the atlantooccipital and atlantoaxial joints, causing vertical subluxation. Magnetic resonance imaging showed spinal cord and brainstem compression and the presence of fluid. Gadolinium-enhanced magnetic resonance imaging showed enhancement around the odontoid process. We performed occipital-cervical spine fixation and C1 laminectomy. Following surgery, his symptoms completely resolved. Bone fusion was confirmed 6 months after surgery. Conclusion: If subluxation of the upper cervical spine occurs rapidly, infection should be considered. Keywords: Atlantoaxial vertical subluxation, pyogenic spondylitis, atlantoaxial joint, atlantooccipital joint.

show abstract

Pyogenic Osteomyelitis of the Atlas

Abstract: Conservative treatment of pyogenic osteomyelitis of the atlas with antibiotics and immobilization was shown to be sufficient in this case.

Cited by 13 publications

References 14 publications

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

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

Vertical subluxation caused by infection around the odontoid process: a case report

Vertical Subluxation Caused by Infection Around the Odontoid Process: A Case Report

Contact Info

Product

Resources

About