Pyogenic osteomyelitis of the odontoid process: single stage decompression and fusion.

STUDY DESIGN: A case report.

OBJECTIVES: To document our experience with single stage decompression and fixation in the treatment of pyogenic osteomyelitis of the odontoid process.

SUMMARY OF BACKGROUND DATA: Although several investigators have reported a handful of these unusual cases, up until now, there have been no studies concerning a single stage solution in the surgical treatment of this pathology.

METHODS: Three patients with osteomyelitis of the odontoid process caused by Staphylococcus aureus underwent surgical treatment in single sessions (transoral decompression combined with posterior fusion as the second step of the operation). Following surgery, the patients underwent a 6-week antibiotic course administered both intravenously and orally. Furthermore, we recommended the use of a hard cervical collar for 8 weeks together with isometric rehabilitation of the cervical muscles. Currently, follow-up results are available for two patients.

RESULTS: On examination at 3 months, 6 months, and 1 year after the surgery, both patients had completely recovered with no neurologic deficit. Plain radiographs showed complete posterior fusion after 6 and 12 months, respectively.

CONCLUSIONS: We emphasize the advantages of our method in comparison with nonoperative treatment or multisession surgery. The single stage surgical solution led to a shortening of hospitalization time with no need for halo bracing, to excellent results with respect to C-spine stability and to better compliance from the patients.