Hematogenous pyogenic facet joint infection of the subaxial cervical spine. A report of two cases and review of the literature

Septic arthritis of the cervical facet joint: Clinical report and review of the literature

BACKGROUND

Facet joint septic arthritis (FJSA) is an uncommon cause of neck pain, most frequently occurring in the lumbosacral spine. Cervical facet joint septic arthritis is particularly rare. Symptoms typically include spinal or paraspinal pain and tenderness, with severe infections potentially causing neurological impairments. This condition can progress to discitis and osteomyelitis. High clinical suspicion is required for accurate diagnosis and timely treatment.

OBJECTIVE

To present the first known case of cervical spine FJSA caused by Moraxella species and provide an updated narrative review of cervical spine FJSA.

METHODS

A case study of a 66-year-old male with cervical spine FJSA caused by Moraxella osloensis is detailed. Additionally, a librarian-assisted literature search was conducted on MEDLINE Pubmed, filtering for adult human trials and including various study types, resulting in the inclusion of 9 relevant manuscripts.

RESULTS

The patient's symptoms included neck, right upper thoracic, and periscapular pain, with episodes of numbness and tingling. MRI revealed septic arthritis at the C7-T1 facet joint and associated osteomyelitis. Cultures identified Moraxella osloensis as the causative agent. The patient was successfully treated with antibiotics and experienced significant symptom improvement. Literature review highlights that Staphylococcus aureus is the most common causative agent of cervical FJSA, with diagnosis typically involving MRI and culture tests. Treatment generally includes long-term antibiotics, with some cases requiring surgical intervention.

CONCLUSIONS

This report underscores the need for high clinical suspicion in diagnosing FJSA and highlights the importance of early intervention. It documents the first known case of cervical spine FJSA caused by Moraxella osloensis, contributing valuable information to the limited literature on this rare condition.

Safety and Feasibility of DTRAX Cervical Cages in the Atlantoaxial Joint for C1/2 Stabilization

BACKGROUND

Pathological changes in the atlantoaxial joint often lead to instability, pain, and neurological deterioration. One treatment option is the surgical stabilization of the atlantoaxial joint. In other areas of the spine, fusion rates have been improved by the introduction of an interbody cage. Our aim was to use cervical interbody spacers, originally designed to augment fusion across subaxial posterior cervical facets, to optimize the conditions for atlantoaxial fusion.

OBJECTIVE

To evaluate the safety and efficacy of implanting cervical cages in the atlantoaxial joint for C1/2 stabilization.

METHODS

Our retrospective study evaluated patients who had undergone C1/2 cervical fusions by the Harms/Goel technique. This technique was modified by implanting a titanium cervical interbody spacer into the joint space. Mean overall pain, as measured by a 0 to 10 visual analog scale (VAS) and neurological outcomes were measured preoperatively and postoperatively. In addition, radiological outcomes were collected using follow-up imaging.

RESULTS

Nine patients were included in this case series. The mean preoperative VAS for overall pain was 5.0 ± 4.0, which changed to a mean VAS of 2.0 ± 3.0 after an average follow-up period of 41.4 ± 20.4 (P = .043). All patients showed a bony fusion in our case series. None of the radiological imaging during follow-up showed screw loosening, hardware breakage, implant migration, or nonunion.

CONCLUSION

The implantation of cervical titanium cages into the atlantoaxial joint in combination with posterior fixation appears to be a safe and effective method for achieving C1/2 fusion.

Cervical facet joint septic arthritis: a real pain in the neck

A 64-year-old man with a complex medical history and previous cervical arthritis with discectomy presents with a 2-day history of neck and lower back pain and shortness of breath, associated with left-sided muscle weakness. He has a fever with severe sepsis causing acute renal failure. MRI spine shows evidence of left cervical facet joint septic arthritis at C6-T1. He required 6 weeks of intravenous antibiotics and intensive support with ventilation and haemofiltration. After completion of antibiotics, he made a full recovery and regained neurological function before discharge.

Cervical spine epidural abscess: a single center analytical comparison to the literature

STUDY DESIGN

Retrospective review of patient charts.

OBJECTIVES

Cervical spine epidural abscess (CSEA) is uncommon. In this study, characteristics of CSEA patients are described through an institutional analysis and literature review.

SETTING

University-affiliated city hospital.

METHODS

The electronic medical record was searched from 01/2001 to 01/2012. Data on presentation, comorbidities, diagnostic modalities, pathogens, treatments, and neurological recovery were collected.

RESULTS

Sixteen patients were identified with a mean age of 57.9 years (33-83). Nine were females. Common symptoms were neck/back pain (62.5%), neurological deficits (62.5%), and fever (31.3%). Comorbidities included cardiovascular disease (56.3%), renal disease (37.5%), and diabetes mellitus (37.5%). Lower levels were more likely afflicted (C5-C7). Microorganisms were commonly Staphylococcus and Streptococcus (68.8%). Eight (50.0%) received surgery (anterior [87.5%] and posterior [12.5%] cervical fusion and corpectomy [37.5%]) plus antibiotics and 8 (50.0%) were treated with antibiotics only. Patients with less comorbidities were more likely to receive surgery; more comorbidities were was associated with a poor prognosis. Eight patients (50%) made had full neurological recovery, 2 (12.5%) with had minimal recovery, 2 deaths died, and the remaining (25%) 1 was were sent to a skilled facility and 1or lost to follow-up.

CONCLUSIONS

Cervical SEA can be problematic. The vast majority do not present classically and treatment does vary. It occurs more frequently in the lower cervical levels. Though antibiotics alone may suffice, surgery is frequently employed and a multitude of techniques are at the utility of the spine surgeon. Cardiovascular comorbidities are associated with a poorer outcome. In order to improve prognosis, management considerations should include both patient factors and multidisciplinary efforts.

Cervical epidural abscess in haemodialysis patients by catheter related infection: report of two cases

Despite advances in neuroimaging and neurosurgical treatment modalities, spinal epidural abscess remains a challenging problem. Early diagnosis is often difficult and treatment is always delayed. Spinal epidural abscess usually develops in patients with predisposing factors such as IV drug abuse, senillity, diabetes mellitus, spinal attempts, alcoholism, immunosuppression, liver diseases and catheterizations. It is rarely seen in cervical region. A successful treatment is only possible with early diagnosis and accurate surgical and medical treatment. Optimal management is unclear and morbidity and mortality are significant. We present two adult haemodialysis patients with end-stage renal insufficiency who developed cervical epidural abscess following central venous catheter placement. Early surgical intervention is mandatory in cases those have progressive neurological deficit and spinal deformity, and this is also increases the success rate of medical therapy.