Multiple abscesses with osteomyelitis and destruction of both the atlas and the axis in a 4-week-old infant

Zoltán Papp, Gábor Czigléczki, Péter Banczerowski

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8 Citations (Scopus)


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 postinfl ammatory 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.

Original languageEnglish
Pages (from-to)E1228-E1230
Issue number19
Publication statusPublished - Sep 1 2013



  • Atlas
  • Axis
  • Cervical spine
  • Osteomyelitis
  • Pediatrics
  • Retropharyngeal abscess

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

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