title: Upper Cervical Epidural Abscess in Clinical Practice: Diagnosis and Management.
abstract: Study Design Narrative review. Objective Upper cervical epidural abscess (UCEA) is a rare surgical emergency. Despite increasing incidence, uncertainty remains as to how it should initially be managed. Risk factors for UCEA include immunocompromised hosts, diabetes mellitus, and intravenous drug use. Our objective is to provide a comprehensive overview of the literature including the history, clinical manifestations, diagnosis, and management of UCEA. Methods Using PubMed, studies published prior to 2015 were analyzed. We used the keywords "Upper cervical epidural abscess," "C1 osteomyelitis," "C2 osteomyelitis," "C1 epidural abscess," "C2 epidural abscess." We excluded cases with tuberculosis. Results The review addresses epidemiology, etiology, imaging, microbiology, and diagnosis of this condition. We also address the nonoperative and operative management options and the relative indications for each as reviewed in the literature. Conclusion A high index of suspicion is required to diagnose this rare condition with magnetic resonance imaging being the imaging modality of choice. There has been a shift toward surgical management of this condition in recent times, with favorable outcomes.
authors.affiliation: Department of Orthopaedic Surgery, Bristol Royal Infirmary, Bristol, England, United Kingdom.
authors.forename: Khalid
authors.initials: K
authors.lastname: Al-Hourani
authors.affiliation: Wayne State University School of Medicine, Detroit, Michigan, United States.
authors.forename: Rami
authors.initials: R
authors.lastname: Al-Aref
authors.affiliation: Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, New York, United States.
authors.forename: Addisu
authors.initials: A
authors.lastname: Mesfin
keywords: atlas; axis; neurologic deficits; odontoid; osteomyelitis; spinal epidural abscess; upper cervical spine