Elsevier

Surgical Neurology

Volume 53, Issue 6, 1 June 2000, Pages 573-579
Surgical Neurology

Original article
Diagnostic pitfalls in osteomyelitis of the odontoid process: case report

https://doi.org/10.1016/S0090-3019(00)00239-1Get rights and content

Abstract

BACKGROUND

Pyogenic osteomyelitis of the odontoid process is a very rare disease associated with a variety of clinical symptoms, and previous reports have stressed the difficulties inherent in making the diagnosis. The authors present a case of osteomyelitis of the odontoid process with epidural abscess in which magnetic resonance imaging (MRI) was used in the diagnosis, assessment of the extent of concomitant epidural abscess, treatment effect, and long-term follow-up.

CASE DESCRIPTION

A 68-year-old male was admitted to our hospital with cervical pain, neck stiffness, and fever. Although the diagnosis was missed at the beginning, the patient was diagnosed with osteomyelitis of the odontoid process with a paravertebral epidural abscess by MRI. The patient became asymptomatic after 3 months of antibiotic therapy.

CONCLUSION

Pyogenic osteomyelitis of the odontoid process is a rare condition requiring a high index of suspicion for diagnosis. MRI examination should be considered in the diagnosis in patients with neck pain combined with fever. Serial MRI during and after antibiotic therapy provided an objective assessment of the healing rate of the lesions.

Section snippets

Case report

A 68-year-old male was admitted to our hospital with a 7-day history of posterior cervical pain, neck stiffness, and fever. There was no recent exposure to tuberculosis and the patient had no recent head or neck injuries. The patient had been treated for diabetes mellitus and hypertension for 3 years. On admission, the patient was alert and well oriented, with a body temperature of 38.6°C. The neck was stiff and painful on palpation; the posterior cervical pain was constant and independent of

Discussion

Pyogenic osteomyelitis most frequently involves irregular, cancellous bones such as the vertebrae, clavicle, sternum, and flat bones of the pelvis in adults 1, 8. Osteomyelitis of the cervical spine is less common than similar diseases in the lumbar or thoracic spine, and osteomyelitis confined to the odontoid process is rarely reported. Despite repeated warnings in the literature, the diagnosis of cervical osteomyelitis is still often missed. Our case showed symptoms compatible with

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