Mathkour Mansour, Chu Julie, Scullen Tyler, Ibrahim Naser, Werner Cassidy, Carr Christopher J, Huang Brendan, Abou-Al-Shaar Hussam, Dallapiazza Robert F, Maulucci Christopher M, Singh Manish
Department of Neurological Surgery, Tulane Medical Center, New Orleans, LA, USA.
Department of Neurological Surgery, Ochsner Clinic Foundation, Ochsner Health System, New Orleans, LA, USA.
J Craniovertebr Junction Spine. 2022 Jul-Sep;13(3):224-232. doi: 10.4103/jcvjs.jcvjs_206_20. Epub 2022 Sep 14.
Cat scratch disease (CSD), caused by , may atypically present with vertebral osteomyelitis. Antibiotic regimens are tailored to presentation, which is markedly variable and not well defined for any atypical disease. In cases of spinal instability, the use of antibiotics alone may not be sufficient. Atlantoaxial instability caused by osteomyelitis is a rare complication of CSD. In this report, we describe the rare case of vertebral osteomyelitis complicated by atlantoaxial instability, requiring both antibiotics and atlantoaxial fusion. We discuss our case, surgical technique, rationale, and outcome. In addition, we conducted a systematic review of the literature of vertebral osteomyelitis in pediatric secondary to . A 2-year-old child presented with a 2-month history of irritability, fever, and rigid neck pain along with a recent history of feline exposure. Physical examination revealed cervical tenderness and decreased range of motion. Computed tomography (CT) showed osteolysis of the right C1 lateral mass and pars articularis; T1-weighted magnetic resonance imaging with contrast showed enhancement around the right C1 lateral mass. The titer for was high. A diagnosis of cat scratch osteomyelitis with cervical instability was made, for which the patient underwent surgery with atlantoaxial fusion. Postoperative imaging demonstrated resolution of the contrast-enhanced lesion. At 6-year follow-up, the patient showed no signs of residual complications from surgical intervention with a solid fusion. Our review revealed 44 cases of pediatric CSD vertebral osteomyelitis. Conservative management with antibiotic employed in 86% while antibiotics with surgical intervention in 14% of the cases. Surgical intervention was most often in the form of incision for drainage and decompression without fusion. Average follow-up 10 months with 86% achieved complete resolution. Cervical instability caused by osteolysis is a rare complication of CSD. This can subsequently lead to vertebral instability, requiring definitive surgical intervention.
猫抓病（CSD）由[病原体未提及]引起，可能非典型地表现为椎体骨髓炎。抗生素治疗方案是根据临床表现制定的，临床表现差异很大，对于任何非典型疾病都没有明确的定义。在脊柱不稳定的情况下，仅使用抗生素可能并不足够。骨髓炎引起的寰枢椎不稳定是CSD的一种罕见并发症。在本报告中，我们描述了一例罕见的椎体骨髓炎并发寰枢椎不稳定的病例，该病例需要同时使用抗生素和进行寰枢椎融合术。我们讨论了我们的病例、手术技术、原理和结果。此外，我们对继发于[病因未提及]的小儿椎体骨髓炎的文献进行了系统综述。一名2岁儿童有2个月的烦躁、发热和颈部僵硬疼痛病史，近期有猫接触史。体格检查发现颈部压痛和活动范围减小。计算机断层扫描（CT）显示右侧C1侧块和关节突骨质溶解；增强T1加权磁共振成像显示右侧C1侧块周围有强化。[相关病原体检测]的滴度很高。诊断为猫抓性骨髓炎伴颈椎不稳定，患者接受了寰枢椎融合手术。术后影像学检查显示强化病变消退。在6年的随访中，患者没有显示出手术干预后残留并发症的迹象，融合稳固。我们的综述发现了44例小儿CSD椎体骨髓炎病例。86%的病例采用抗生素保守治疗，14%的病例采用抗生素联合手术干预。手术干预最常见的形式是切开引流和减压而不进行融合。平均随访10个月，86%的病例完全缓解。骨质溶解引起的颈椎不稳定是CSD的一种罕见并发症。这随后可能导致椎体不稳定，需要进行明确的手术干预。
