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Spine
Diagnosis
Infection and Inflammatory Disorders
Infections
Osteomyelitis, C1-C2
Osteomyelitis, C1-C2
Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Synonyms

                • Atlantoaxial osteomyelitis

              • Definitions

                • Infection of C1-C2 articulation [pyogenic or tuberculous (TB)]

              IMAGING

              • General Features

                • Radiographic Findings

                  • Fluoroscopic Findings

                    • CT Findings

                      • MR Findings

                        • Nonvascular Interventions

                          • Nuclear Medicine Findings

                            • Imaging Recommendations

                              DIFFERENTIAL DIAGNOSIS

                                PATHOLOGY

                                • General Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              Selected References

                                              1. dBao D et al: Treatment of atlantoaxial tuberculosis with neurological impairment: a systematic review. World Neurosurg. 135:7-13, 2020
                                              2. Mattke AC et al: Lemierre's syndrome, necrotizing pneumonia and staphylococcal septic shock treated with extracorporeal life support. SAGE Open Med Case Rep. 5:2050313X17722726, 2017
                                              3. Al-Hourani K et al: Upper cervical epidural abscess in clinical practice: diagnosis and management. Global Spine J. 6(4):383-93, 2016
                                              4. Mazur MD et al: Avoiding early complications and reoperation during occipitocervical fusion in pediatric patients. J Neurosurg Pediatr. 14(5):465-75, 2014
                                              5. Coca-Pelaz A et al: Grisel's syndrome as a sequela of a complicated acute mastoiditis. Acta Otorrinolaringol Esp. 64(2):161-4, 2013
                                              6. Kumar N et al: Craniovertebral junction tuberculosis. BMJ Case Rep. 2013:bcr2013202136, 2013
                                              7. Yamane K et al: Severe rotational deformity, quadriparesis and respiratory embarrassment due to osteomyelitis at the occipito-atlantoaxial junction. J Bone Joint Surg Br. 92(2):286-8, 2010
                                              8. Sibai TA et al: Infectious Collet-Sicard syndrome in the differential diagnosis of cerebrovascular accident: a case of head-to-neck dissociation with skull-based osteomyelitis. Spine J. 9(4):e6-e10, 2009
                                              9. Chadha M et al: Craniovertebral tuberculosis: a retrospective review of 13 cases managed conservatively. Spine (Phila Pa 1976). 32(15):1629-34, 2007
                                              10. Gupta JD et al: Severe muscle spasm of the neck secondary to osteomyelitis of the atlantoaxial joint. Ear Nose Throat J. 86(7):380-1, 2007
                                              11. Reid PJ et al: Iatrogenic pyogenic osteomyelitis of C-1 and C-2 treated with transoral decompression and delayed posterior occipitocervical arthrodesis. Case report. J Neurosurg Spine. 7(6):664-8, 2007
                                              12. Sasaki K et al: Septic arthritis of the atlantoaxial joint: case report. J Spinal Disord Tech. 19(8):612-5, 2006
                                              13. Krishnan A et al: Craniovertebral junction tuberculosis: a review of 29 cases. J Comput Assist Tomogr. 25(2): 171-6, 2001
                                              14. Chan LL et al: Imaging of mucormycosis skull base osteomyelitis. AJNR Am J Neuroradiol. 21(5): 828-31, 2000
                                              15. Magliulo G et al: Osteomyelitis of the skull base with atypical onset and evolution. Ann Otol Rhinol Laryngol. 109(3): 326-30, 2000
                                              16. Subburaman N et al: Skull base osteomyelitis interpreted as malignancy. J Laryngol Otol. 113(8): 775-8, 1999
                                              17. Chong VF et al: The retropharyngeal space: route of tumour spread. Clin Radiol. 53(1): 64-7, 1998
                                              18. Jones DC et al: Oropharyngeal morbidity following transoral approaches to the upper cervical spine. Int J Oral Maxillofac Surg. 27(4): 295-8, 1998
                                              19. Swift AC et al: Skull base osteitis following fungal sinusitis. J Laryngol Otol. 112(1): 92-7, 1998
                                              20. Baker LL et al: Atlanto-axial subluxation and cervical osteomyelitis: two unusual complications of adenoidectomy. Ann Otol Rhinol Laryngol. 105(4):295-9, 1996
                                              21. Khanna RK et al: Spinal epidural abscess: evaluation of factors influencing outcome. Neurosurgery. 39(5):958-64, 1996
                                              22. Lam CH et al: Conservative therapy of atlantoaxial osteomyelitis. A case report. Spine. 21(15):1820-3, 1996
                                              23. Gormley W et al: Spontaneous atlantoaxial osteomyelitis: no longer a rare case? Case report. Neurosurgery. 35(1):132-5; discussion 135-6, 1994
                                              24. Wetzel FT et al: Grisel's syndrome. Clin Orthop. (240):141-52, 1989
                                              25. Wilson BC et al: Nontraumatic subluxation of the atlantoaxial joint: Grisel's syndrome. Ann Otol Rhinol Laryngol. 96(6):705-8, 1987
                                              26. Zigler JE et al: Pyogenic osteomyelitis of the occiput, the atlas, and the axis. A report of five cases. J Bone Joint Surg Am. 69(7):1069-73, 1987
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Pathology

                                                      • Clinical Issues

                                                        • Diagnostic Checklist

                                                          TERMINOLOGY

                                                          • Synonyms

                                                            • Atlantoaxial osteomyelitis

                                                          • Definitions

                                                            • Infection of C1-C2 articulation [pyogenic or tuberculous (TB)]

                                                          IMAGING

                                                          • General Features

                                                            • Radiographic Findings

                                                              • Fluoroscopic Findings

                                                                • CT Findings

                                                                  • MR Findings

                                                                    • Nonvascular Interventions

                                                                      • Nuclear Medicine Findings

                                                                        • Imaging Recommendations

                                                                          DIFFERENTIAL DIAGNOSIS

                                                                            PATHOLOGY

                                                                            • General Features

                                                                              CLINICAL ISSUES

                                                                              • Presentation

                                                                                • Demographics

                                                                                  • Natural History & Prognosis

                                                                                    • Treatment

                                                                                      DIAGNOSTIC CHECKLIST

                                                                                      • Consider

                                                                                        • Image Interpretation Pearls

                                                                                          Selected References

                                                                                          1. dBao D et al: Treatment of atlantoaxial tuberculosis with neurological impairment: a systematic review. World Neurosurg. 135:7-13, 2020
                                                                                          2. Mattke AC et al: Lemierre's syndrome, necrotizing pneumonia and staphylococcal septic shock treated with extracorporeal life support. SAGE Open Med Case Rep. 5:2050313X17722726, 2017
                                                                                          3. Al-Hourani K et al: Upper cervical epidural abscess in clinical practice: diagnosis and management. Global Spine J. 6(4):383-93, 2016
                                                                                          4. Mazur MD et al: Avoiding early complications and reoperation during occipitocervical fusion in pediatric patients. J Neurosurg Pediatr. 14(5):465-75, 2014
                                                                                          5. Coca-Pelaz A et al: Grisel's syndrome as a sequela of a complicated acute mastoiditis. Acta Otorrinolaringol Esp. 64(2):161-4, 2013
                                                                                          6. Kumar N et al: Craniovertebral junction tuberculosis. BMJ Case Rep. 2013:bcr2013202136, 2013
                                                                                          7. Yamane K et al: Severe rotational deformity, quadriparesis and respiratory embarrassment due to osteomyelitis at the occipito-atlantoaxial junction. J Bone Joint Surg Br. 92(2):286-8, 2010
                                                                                          8. Sibai TA et al: Infectious Collet-Sicard syndrome in the differential diagnosis of cerebrovascular accident: a case of head-to-neck dissociation with skull-based osteomyelitis. Spine J. 9(4):e6-e10, 2009
                                                                                          9. Chadha M et al: Craniovertebral tuberculosis: a retrospective review of 13 cases managed conservatively. Spine (Phila Pa 1976). 32(15):1629-34, 2007
                                                                                          10. Gupta JD et al: Severe muscle spasm of the neck secondary to osteomyelitis of the atlantoaxial joint. Ear Nose Throat J. 86(7):380-1, 2007
                                                                                          11. Reid PJ et al: Iatrogenic pyogenic osteomyelitis of C-1 and C-2 treated with transoral decompression and delayed posterior occipitocervical arthrodesis. Case report. J Neurosurg Spine. 7(6):664-8, 2007
                                                                                          12. Sasaki K et al: Septic arthritis of the atlantoaxial joint: case report. J Spinal Disord Tech. 19(8):612-5, 2006
                                                                                          13. Krishnan A et al: Craniovertebral junction tuberculosis: a review of 29 cases. J Comput Assist Tomogr. 25(2): 171-6, 2001
                                                                                          14. Chan LL et al: Imaging of mucormycosis skull base osteomyelitis. AJNR Am J Neuroradiol. 21(5): 828-31, 2000
                                                                                          15. Magliulo G et al: Osteomyelitis of the skull base with atypical onset and evolution. Ann Otol Rhinol Laryngol. 109(3): 326-30, 2000
                                                                                          16. Subburaman N et al: Skull base osteomyelitis interpreted as malignancy. J Laryngol Otol. 113(8): 775-8, 1999
                                                                                          17. Chong VF et al: The retropharyngeal space: route of tumour spread. Clin Radiol. 53(1): 64-7, 1998
                                                                                          18. Jones DC et al: Oropharyngeal morbidity following transoral approaches to the upper cervical spine. Int J Oral Maxillofac Surg. 27(4): 295-8, 1998
                                                                                          19. Swift AC et al: Skull base osteitis following fungal sinusitis. J Laryngol Otol. 112(1): 92-7, 1998
                                                                                          20. Baker LL et al: Atlanto-axial subluxation and cervical osteomyelitis: two unusual complications of adenoidectomy. Ann Otol Rhinol Laryngol. 105(4):295-9, 1996
                                                                                          21. Khanna RK et al: Spinal epidural abscess: evaluation of factors influencing outcome. Neurosurgery. 39(5):958-64, 1996
                                                                                          22. Lam CH et al: Conservative therapy of atlantoaxial osteomyelitis. A case report. Spine. 21(15):1820-3, 1996
                                                                                          23. Gormley W et al: Spontaneous atlantoaxial osteomyelitis: no longer a rare case? Case report. Neurosurgery. 35(1):132-5; discussion 135-6, 1994
                                                                                          24. Wetzel FT et al: Grisel's syndrome. Clin Orthop. (240):141-52, 1989
                                                                                          25. Wilson BC et al: Nontraumatic subluxation of the atlantoaxial joint: Grisel's syndrome. Ann Otol Rhinol Laryngol. 96(6):705-8, 1987
                                                                                          26. Zigler JE et al: Pyogenic osteomyelitis of the occiput, the atlas, and the axis. A report of five cases. J Bone Joint Surg Am. 69(7):1069-73, 1987