Pyogenic osteomyelitis of the odontoid process: single stage decompression and fusion.
METHODS
A case report.


OBJECTIVE
To document our experience with single stage decompression and fixation in the treatment of pyogenic osteomyelitis of the odontoid process.


BACKGROUND
Although several investigators have reported a handful of these unusual cases, up until now, there have been no studies concerning a single stage solution in the surgical treatment of this pathology.


METHODS
Three patients with osteomyelitis of the odontoid process caused by Staphylococcus aureus underwent surgical treatment in single sessions (transoral decompression combined with posterior fusion as the second step of the operation). Following surgery, the patients underwent a 6-week antibiotic course administered both intravenously and orally. Furthermore, we recommended the use of a hard cervical collar for 8 weeks together with isometric rehabilitation of the cervical muscles. Currently, follow-up results are available for two patients.


RESULTS
On examination at 3 months, 6 months, and 1 year after the surgery, both patients had completely recovered with no neurologic deficit. Plain radiographs showed complete posterior fusion after 6 and 12 months, respectively.


CONCLUSIONS
We emphasize the advantages of our method in comparison with nonoperative treatment or multisession surgery. The single stage surgical solution led to a shortening of hospitalization time with no need for halo bracing, to excellent results with respect to C-spine stability and to better compliance from the patients.
Suchomel
Petr
P
Department of Neurosurgery, Hospital Liberec, Liberec, Czech Republic. petr.suchomel@nemlib.cz
Buchvald
Pavel
P
Barsa
Pavel
P
Lukas
Richard
R
Soukup
Tomas
T
D000038:Abscess / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D000900:Anti-Bacterial Agents; D019299:Decompression, Surgical; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009809:Odontoid Process / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D010019:Osteomyelitis / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D013122:Spinal Diseases / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents