Atlanto-axial subluxation after pyogenic spondylitis of the atlanto-occipital joint

作者：Tsunoda Kazuhiko; Iizuka Haku^*; Sorimachi Yasunori; Ara Tsuyoshi; Nishinome Masahiro; Takechi Yasuhiko; Takagishi Kenji

来源：European Spine Journal, 2011, 20: S253-S257.

DOI：10.1007/s00586-010-1651-z

• Atlanto-axial subluxation
• Atlanto-occipital joint
• Pyogenic spondylitis

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.

• 出版日期2011-7