Multiple Abscesses With Osteomyelitis and Destruction of Both the Atlas and the Axis in a 4-Week-Old Infant

Abstract

In Brief Study Design. Case report. Objective. To report an unusual case of a 4-week-old infant with multiple abscesses, which propagated to the cervical region and destroyed the C1–C2 vertebrae. Summary of Background Data. Cervical vertebral osteomyelitis involving the atlas and axis in childhood is distinctly unusual, which may lead to the rapid destruction of the vertebral body. Propagation of a retropharyngeal abscess is the major cause of cervical vertebral osteomyelitis. Only a limited number of infant case reports are published, and no case of osteomyelitis with the destruction of both the atlas and the dens axis has been reported previously. Methods. A 1-month-old infant with multiple craniospinal and thoracic abscesses was surgically treated. Therapy was completed with antibiotics and immobilization. Follow-up was carried out with magnetic resonance imaging, computed tomographic scans, and functional radiographical diagnostics. Results. The retropharyngeal and thoracic abscesses were surgically removed. The infant was placed in a custom-made fixation device for 8 weeks. Two months later, follow-up functional examination revealed no significant instability of the cervical spine. During a 3-year-long follow-up period, no signs of neurological impairment were observed, neck movements were limited but painless. It is assumed that the remnants of the bony elements of C1–C2 vertebrae and the massive interconnecting postinflammatory scar tissue make some degree of neck movements possible. Conclusion. C1–C2 osteomyelitis is a very rare entity even in children. There is limited experience with treatment, but immobilization of the neck, surgical debridement, drainage, and antibiotic treatment can be recommended. Close follow-up is required to check the reconstitution of affected bones and ligaments, any development of instability, and the necessity of surgical stabilization. Level of Evidence: N/A Cervical vertebral osteomyelitis involving both the atlas and the axis was treated in a 4-week-old infant. Surgical decompression was performed, combined with antibiotic treatment and postoperative immobilization with the help of a custom-made device. At the follow-up of 3 years, the child's neck movements were moderately limited, but painless, and no neurological impairment was observed.