Septic Arthritis of the Atlantoaxial Joint

Abstract

Bacterial epidural abscess formation of cervical spine was rarely seen and all these cases were associated with osteomyelitis of the odontoid process. To the author's knowledge, only 1 case of septic arthritis of the C1-C2 lateral facet joint has been reported in the English literature. A 76-year-old woman presented with progressive neck pain and stiffness in the left side of her neck with fever. Coronal computed tomography clearly demonstrated destructive change of the atlantoaxial joint. Contrast magnetic resonance imaging demonstrated infection of the atlantoaxial joint resulting in epidural abscess formation. Because of lack of neurologic deficit, we treated her with halo-fixation together with appropriate antibiotics administration. The patient was successfully treated with antibiotics and immobilization. Septic arthritis of the lateral atlantoaxial joint should be added to the differential diagnosis of severe neck pain with fever, although it is very rare clinical entity. Early analysis of computerized tomography and magnetic resonance imaging although maintaining a high suspicion for this disease is mandatory to avoid delayed diagnosis and subsequent morbidity.

Pyogenic Osteomyelitis of the Atlas

“…In the case of early diagnosis of infection of the upper cervical spine region, conservative treatment with antibiotics and immobilization is likely to be sufficient 15,16 as was shown in this case. In the current case, CT scanning was done immediately because of severe neck pain and the clinical suspicion of inflammatory disease.…”

Iatrogenic pyogenic osteomyelitis of C-1 and C-2 treated with transoral decompression and delayed posterior occipitocervical arthrodesis

“…Elias 8 reported a single case of subaxial epidural abscess after a trigger point injection. Halla and associates 10 and Sasaki et al 19 have both reported septic arthritis of the atlantoaxial joint, but these cases did not involve prior injection therapy. Yazawa and colleagues 24 described a case of cervical epidural abscess and osteomyelitis of C-1 and C-2 after acupuncture treatment for chronic neck pain.…”

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

“…Early infection of the atlanto-axial junction is difficult to diagnose, as symptoms are usually vague and variable, and radiographs usually show overlapping shadow of the occiput, maxillary sinus and dental artefacts. 5 When the diagnosis is early, antibiotic treatment alone should suffice 1,6 ; otherwise, surgical drainage is needed. Prompt diagnosis requires a high degree of clinical suspicion, with timely use of modern imaging modalities.…”