Anterior Microscopic Transtubular (MITR) Surgical Approach for Cervical Pyogenic C1-2 Abscess: A Case Report

Osteomyelitis of the spine is a fairly uncommon event following an orthopedic surgical procedure. However, a solitary osteomyelitic abscess of the upper cervical spine is very rare. Surgical intervention is often the only life-saving treatment method. A 70-year-old female patient with diabetes was received from a rural community with symptoms of progressive quadraparesis and progressive respiratory failure. A CT scan of the cervical spine showed a destruction of the C1 and C2 complex, as well as the left occipital condyle, and clear evidence of craniocervical instability. She underwent surgical debridement of the abscess via an anterior microscopic transtubular approach, followed by a posterior occipital-cervical fusion. While a transoral approach is a well-established procedure for the anterior clivus/C1-2 area, it is fraught with a high degree of morbidity and mortality. The use of the transtubular anterior cervical approach in this case allowed us to access the C1-2 area with ease and minimal effort. From a technical standpoint, this type of approach for treatment of this condition has not been previously documented in the literature.