Acute neck pain caused by septic arthritis of the lateral atlantoaxial joint with subluxation: a case report

Journal of Medical Case Reports

Yoichi Shimada²  Kazuma Kikuchi¹  Toshiki Abe¹  Eiji Abe¹  Naohisa Miyakoshi²  Takashi Kobayashi¹ 

[1] Department of Orthopedic Surgery, Akita Kousei Medical Center, 1-1-1 Iijima-Nishifukuro, Akita 011-0948, Japan;Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan

关键词: Vertebral osteomyelitis;    Surgical immobilization;    Septic arthritis;    Lateral atlantoaxial joint;    Cervical spine;   

Others  :  1231398
DOI  :  10.1186/s13256-015-0651-3

 received in 2015-04-03, accepted in 2015-07-10,  发布年份 2015

【 摘 要 】

Introduction

Crystal-induced arthritis of the lateral atlantoaxial joint may be intimately involved in acute neck pain in the elderly. Patients typically have a good prognosis, and symptoms usually subside within a few weeks. On the other hand, septic arthritis of the lateral atlantoaxial joint requires early diagnosis and antibiotic treatment. Diagnostic delay is a risk factor for an unfavorable outcome of vertebral osteomyelitis. Even though septic arthritis of the lateral atlantoaxial joint is a very rare clinical entity, it is important to differentiate septic arthritis from crystal-induced arthritis.

Case presentation

A 53-year-old Japanese man presented with neck pain, stiffness, and loss of power of his left upper extremity which started 20 days before his visit to our hospital. A physical examination revealed a limited range of motion of his neck, with rotation being especially very restricted. Atlantoaxial subluxation was seen on plain radiography of his cervical spine. During puncture of the lateral atlantoaxial joint, clear yellow fluid was collected. Cultures later grew methicillin-sensitive Staphylococcus aureus. He was diagnosed with septic arthritis of the lateral atlantoaxial joint with atlantoaxial subluxation. After diagnosis, intravenous administration of antibiotics was begun. The atlantoaxial region was stabilized with the Brooks procedure. Plain radiography showed complete bone union 8 months after operation. At a follow-up evaluation 7 years after initial onset, he had complete relief of neck pain, and there were no neurological abnormalities.

Conclusions

A patient with septic arthritis of the lateral atlantoaxial joint with subluxation presenting with acute neck pain was successfully treated with antibiotics and fusion surgery. In patients with persistent neck pain, septic arthritis of the lateral atlantoaxial joint should be considered and further examinations performed.

【 授权许可】

   
2015 Kobayashi et al.

【 图 表 】

Fig. 1.

Fig. 2.

Fig. 3.

Fig. 4.

Fig. 5.

【 参考文献 】

• [1]Kobayashi T, Miyakoshi N, Konno N, Abe E, Ishikawa Y, Shimada Y. Acute neck pain caused by arthritis of the lateral atlantoaxial joint. Spine J. 2014; 14:1909-13.
• [2]Compes P, Rakotozanany P, Dufour H, Fuentes S. Spontaneous atlantoaxial pyogenic arthritis surgically managed. Eur Spine J. 2015; 24 Suppl 4:461-4.
• [3]Halla JT, Bliznak J, Hardin JG, Finn S. Septic arthritis of the C1-C2 lateral facet joint and torticollis: pseudo-Grisel’s syndrome. Arthritis Rheum. 1991; 34:84-8.
• [4]Jones JL, Ernst AA. Unusual cause of neck pain: septic arthritis of a cervical facet. Am J Emerg Med. 2012; 2094(30):e1-4.
• [5]Sasaki K, Nabeshima Y, Ozaki A et al.. Septic arthritis of the atlantoaxial joint: case report. J Spinal Disord Tech. 2006; 19:612-5.
• [6]McHenry MC, Easley KA, Locker GA. Vertebral osteomyelitis: long-term outcome for 253 patients from 7 Cleveland-area hospitals. Clin Infect Dis. 2002; 34:1342-50.
• [7]Wetzel FT, La Rocca H. Grisel’s syndrome. Clin Orthop Relat Res. 1989; 240:141-52.
• [8]Bocciolini C, Dall'Olio D, Cunsolo E, Cavazzuti PP, Laudadio P. Grisel's syndrome: a rare complication following adenoidectomy. Acta Otorhinolaryngol Ital. 2005; 25:245-9.
• [9]Sia KJ, Tang IP, Kong CK, Nasriah A. Grisel's syndrome: a rare complication of tonsillectomy. J Laryngol Otol. 2012; 126:529-31.
• [10]Pilge H, Prodinger PM, Bürklein D, Holzapfel BM, Lauen J. Nontraumatic subluxation of the atlanto-axial joint as rare form of acquired torticollis: diagnosis and clinical features of the Grisel's syndrome. Spine (Phila Pa 1976). 2011; 36:E747-51.
• [11]Yamazaki M, Someya Y, Aramomi M, Masaki Y, Okawa A, Koda M. Infection-related atlantoaxial subluxation (Grisel syndrome) in an adult with Down syndrome. Spine (Phila Pa 1976). 2008; 33:E156-60.
• [12]Brooks AL, Jenkins EB. Atlanto-axial arthrodesis by the wedge compression method. J Bone Joint Surg Am. 1978; 60:279-84.
• [13]Butler JS, Shelly MJ, Timlin M, Powderly WG, O’Byrne JM. Nontuberculous pyogenic spinal infection in adults: a 12-year experience from a tertiary referral center. Spine (Phila Pa 1976). 2006; 31:2695-700.
• [14]Chelsom J, Solberg CO. Vertebral osteomyelitis at a Norwegian university hospital 1987–97: clinical features, laboratory findings and outcome. Scand J Infect Dis. 1998; 30:147-51.
• [15]Cheung WY, Luk KD. Pyogenic spondylitis. Int Orthop. 2012; 36:397-404.
• [16]Forsythe M, Rothman RH. New concepts in the diagnosis and treatment of infections of the cervical spine. Orthop Clin North Am. 1978; 9:1039-51.
• [17]Kubo S, Takimoto H, Hosoi K, Toyota S, Karasawa J, Yoshimine T. Osteomyelitis of the odontoid process associated with meningitis and retropharyngeal abscess: case report. Neurol Med Chir (Tokyo). 2002; 42:447-51.
• [18]Kurimoto M, Endo S, Ohi M, Hirashima Y, Matsumura N, Takaku A. Pyogenic osteomyelitis of an invaginated odontoid process with rapid deterioration of high cervical myelopathy: a case report. Acta Neurochir (Wien). 1998; 140:1093-4.
• [19]Leach RE, Goldstein HH, Younger D. Osteomyelitis of the odontoid process. A case report. J Bone Joint Surg Am. 1967; 49:369-71.
• [20]Limbird TJ, Brick GW, Boulas HJ, Bucholz RW. Osteomyelitis of the odontoid process. J Spinal Disord. 1988; 1:66-74.
• [21]Noguchi S, Yanaka K, Yamada Y, Nose T. Diagnostic pitfalls in osteomyelitis of the odontoid process: case report. Surg Neurol. 2000; 53:573-8.
• [22]Rajpal S, Chanbusarakum K, Deshmukh PR. Upper cervical myelopathy due to arachnoiditis and spinal cord tethering from adjacent C-2 osteomyelitis. Case report and review of the literature. J Neurosurg Spine. 2007; 6:64-7.
• [23]Rimalovski AB, Aronson SM. Abscess of medulla oblongata associated with osteomyelitis of odontoid process. Case report. J Neurosurg. 1968; 29:97-101.
• [24]Ruskin J, Shapiro S, McCombs M, Greenberg H, Helmer E. Odontoid osteomyelitis. An unusual presentation of an uncommon disease. West J Med. 1992; 156:306-8.
• [25]Suchomel P, Buchvald P, Barsa P, Lukas R, Soukup T. Pyogenic osteomyelitis of the odontoid process: single stage decompression and fusion. Spine (Phila Pa 1976). 2003; 28:E239-44.
• [26]Venger BH, Musher DM, Brown EW, Baskin DS. Isolated C-2 osteomyelitis of hematogenous origin: case report and literature review. Neurosurgery. 1986; 18:461-4.
• [27]Wiedau-Pazos M, Curio G, Grüsser C. Epidural abscess of the cervical spine with osteomyelitis of the odontoid process. Spine (Phila Pa 1976). 1999; 24:133-6.
• [28]Young WF, Weaver M. Isolated pyogenic osteomyelitis of the odontoid process. Scand J Infect Dis. 1999; 31:512-5.
• [29]Goto S, Umehara J, Aizawa T, Kokubun S. Crowned Dens syndrome. J Bone Joint Surg Am. 2007; 89:2732-6.
• [30]Edlow BL, Wainger BJ, Frosch MP, Copen WA, Rathmell JP, Rost NS. Posterior circulation stroke after C1-C2 intraarticular facet steroid injection: evidence for diffuse microvascular injury. Anesthesiology. 2010; 112:1532-5.
• [31]Busche M, Bastian L, Riedemann NC, Brachvogel P, Rosenthal H, Krettek C. Complete osteolysis of the dens with atlantoaxial luxation caused by infection with Staphylococcus aureus: a case report and review of the literature. Spine (Phila Pa 1976). 2005; 30:E369-74.
• [32]Abe E, Yan K, Okada K. Pyogenic vertebral osteomyelitis presenting as single spinal compression fracture: a case report and review of the literature. Spinal Cord. 2000; 38:639-44.
• [33]Menon VK, Kumar KM, Al GK. One-stage biopsy, debridement, reconstruction, and stabilization of pyogenic vertebral osteomyelitis. Global Spine J. 2014; 4:93-100.
• [34]Mohamed AS, Yoo J, Hart R et al.. Posterior fixation without debridement for vertebral body osteomyelitis and discitis. Neurosurg Focus. 2014; 37: Article ID E6
• [35]Goel A, Kulkarni AG, Sharma P. Reduction of fixed atlantoaxial dislocation in 24 cases: technical note. J Neurosurg Spine. 2005; 2:505-9.
• [36]Harms J, Melcher RP. Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976). 2001; 26:2467-71.
• [37]Magerl F, Seemann P-S. Stable posterior fusion of the atlas and axis by transarticular screw fixation. In: Cervical Spine I. Kehr P, Weidner A, editors. Springer, Wien, Austria; 1987: p.322-7.
• [38]Grob D, Crisco JJ, Panjabi MM, Wang P, Dvorak J. Biomechanical evaluation of four different posterior atlantoaxial fixation techniques. Spine (Phila Pa1976). 1992; 17:480-90.