• Zoltán Papp, Gábor Czigléczki, and Péter Banczerowski.
• *National Institute of Neurosurgery, Budapest, Hungary; and †Department of Neurosurgery, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
• Spine. 2013 Sep 1;38(19):E1228-30.

Study DesignCase report.ObjectiveTo 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 DataCervical 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.MethodsA 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.ResultsThe 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.ConclusionC1-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.

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