Spontaneous atlantoaxial pyogenic arthritis surgically managed.
OBJECTIVE
Septic cervical facet joints arthritis is a rare pathology, usually revealed by fever and neck pain. As symptoms may be indolent, a high index of suspicion needs to be maintained. Magnetic resonance imaging (MRI) is effective for early diagnostic, looking for local spread and guiding potential preoperative planning. We present a case exhibiting an uncommon pathology with possible significant morbidity if misdiagnosed.


METHODS
A 75-year-old woman presented with fever, neck stiffness and torticollis accompanied with altered level of consciousness.


RESULTS
The diagnosis was established by computed tomography and MRI, identifying atlantoaxial facet joint destruction with para spinal muscles and epidural abscesses. A surgical treatment consisting in posterior decompression of the spinal canal and atlantoaxial pars articularis fixation known as Harms technique, associated with a targeted antibiotic therapy, succeeded in obtaining favorable clinical course.


CONCLUSIONS
Atlantoaxial septic arthritis is an under reported and severe infection. Early use of MRI should avoid delayed diagnosis and would guide the practitioner in choosing an appropriate therapy. Early surgical treatment for uncontrolled sepsis is also a critical element of the prognosis.
Department of Neurosurgery, Timone Hospital, 264 rue Saint Pierre, 13385, Marseille, France, paloma.compes@gmail.com.
Paloma
P
Compes
Patrick
P
Rakotozanany
Henry
H
Dufour
Stéphane
S
Fuentes
D000368:Aged; D001170:Arthritis, Infectious / Q000175:diagnosis / Q000601:surgery*; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D019637:Orthopedic Procedures / Q000379:methods*; D014057:Tomography, X-Ray Computed; D021801:Zygapophyseal Joint / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*