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.

• Authors: Kazuhiko Tsunoda, Haku Iizuka, Yasunori Sorimachi, Tsuyoshi Ara, Masahiro Nishinome, Yasuhiko Takechi, Kenji Takagishi
• Journal: European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society (Eur Spine J) Vol. 20 Suppl 2 Pg. S253-7 (Jul 2011) ISSN: 1432-0932 [Electronic] Germany
• PMID: 21140176 (Publication Type: Case Reports, Journal Article)

Topics

• Atlanto-Axial Joint (diagnostic imaging, injuries, surgery)
• Atlanto-Occipital Joint (diagnostic imaging, surgery)
• Humans
• Joint Dislocations (complications, diagnostic imaging, surgery)
• Joint Instability (diagnostic imaging, surgery)
• Male
• Middle Aged
• Radiography
• Spinal Fusion
• Spondylitis (complications, diagnostic imaging, surgery)
• Treatment Outcome