title: [A woman in her fifties with neck pain and increased sedimentation rate].
abstract: BACKGROUND
  Spondylitis in the upper cervical spine can have an insidious onset, with symptoms mimicking low-grade infections or common musculoskeletal disorders. Some patients have neurological symptoms, and if untreated, the outcome may be fatal.
  
  
  METHODS
  A woman in her fifties had general malaise, weight loss and neck pain over 6-8 weeks. Her sedimentation rate was elevated, and she developed bulbar symptoms. Biopsy and culture samples were harvested endoscopically from the prevertebral area in the C1-C2 region, and confirmed our preliminary diagnosis of localised infection. She was treated with high-dose antibiotics and rigid collar immobilisation until stability of the cervical spine was ascertained.
  
  
  CONCLUSIONS
  It is difficult to make a differential diagnosis between spondylitis, rheumatoid inflammation and malignancy in the upper cervical spine. Adequate histologic and bacterial culture samples must if possible be obtained from the prevertebral area. This is best achieved transnasally or transorally, under endoscopic and radiological guidance. The neck must be stabilised and patients must have long-term antibiotic treatment followed by permanent neck fixation if indicated.
authors.affiliation: Fagområdet øre-nese-hals Nevro- og ortopediklinikken Universitetssykehuset Nord-Norge og Øre-nese-hals-seksjonen Institutt for klinisk medisin Universitetet i Tromsø
authors.forename: Niels Christian
authors.initials: NC
authors.lastname: Stenklev
authors.affiliation: Fagområdet øre-nese-hals Nevro- og ortopediklinikken Universitetssykehuset Nord-Norge.
authors.forename: Harald
authors.initials: H
authors.lastname: Rusten
authors.affiliation: Fagområdet nevrokirurgi Nevro- og ortopediklinikken Universitetssykehuset Nord-Norge og Institutt for klinisk medisin Universitetet i Tromsø
authors.forename: Kay
authors.initials: K
authors.lastname: Müller
authors.affiliation: Fagområdet nevrokirurgi Nevro- og ortopediklinikken Universitetssykehuset Nord-Norge og Institutt for klinisk medisin Universitetet i Tromsø
authors.forename: Rune
authors.initials: R
authors.lastname: Hennig
authors.affiliation: Avdeling for klinisk patologi Universitetssykehuset Nord-Norge.
authors.forename: Tormod
authors.initials: T
authors.lastname: Eggen
authors.affiliation: Radiologisk avdeling Diagnostisk klinikk Universitetssykehuset Nord-Norge.
authors.forename: Gry
authors.initials: G
authors.lastname: Wikran
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001799:Blood Sedimentation; D002574:Cervical Vertebrae / Q000382:microbiology; D015299:Discitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008875:Middle Aged; D019547:Neck Pain / Q000382:microbiology*; D010019:Osteomyelitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents