Osteomyelitis of the cervical spine: a potentially dramatic disease

Osteomyelitis of the cervical spine is a rare disease, representing only 3% to 6% of all cases of vertebral osteomyelitis. In contrast with other locations of spinal infections, osteomyelitis of the cervical spine can be a much more dramatic and rapidly deteriorating process, leading to early neurologic deficit. Thus, the disease must be diagnosed quickly and appropriate therapy initiated as soon as possible. The clinical course, therapy, and outcome of 15 patients treated for osteomyelitis of the cervical spine are presented. Nine of 15 patients presented with a neurologic deficit at the time of diagnosis. Surgical treatment consisted of radical debridement of the infected bone and either immediate bone grafting and stabilization as a one-step procedure or interval antibiotic treatment before bone grafting and surgical stabilization as a second procedure. A favorable outcome was achieved by early and aggressive surgical intervention, including complete resolution of neurologic deficits in more than 50% of the patients and complete bony fusion in all but one patient. The authors prefer additional posterior rather than anterior stabilization alone to perform fusion over a shorter distance involving only the infected segments.