Abscess of C1/C2 cervical vertebrae – errors in diagnosis and therapy

Abstract

Background. Nonspecific upper cervical spine vertebra osteomyelitis is very rare. It is caused most often by contiguous spread from an adjacent focus of infection and rarely by haematogenous dissemination from an extraspinal one. We present a rare case of Coagulase-negative Stahylococcus spp cervical vertebra osteomyelitis, where the clinical presentation of the disease is often atypical.

Case report. We analysed the case of 57-year-old female, where we found the diagnostic error in identification of the atlas subluxation on the radiograph and neglected laboratory findings indicating the urinary infection. These led to the disease progression and occurrence of neurological sympthomatology, presented with tetraparesis. A prompt surgery in two steps was planned: the urgent surgical anterior decompression and then the occipitocervical fixation, but the patient died after the first surgical session.

Conclusions. The early recognition of symptoms and a prompt diagnosis are always essential for the onset of the accurate therapy. An additional destabilization of the affected segment done by the surgical decompression in the fist step without the adequate stabilization may lead, as shown here, to a sudden fatal outcome.