Abstract
Spinal abscess is a rare condition. Its presentation can often be subtle and insidious. This report describes the diagnosis and management of an 87-year-old man who presented to our orthopaedic clinic. We would like to emphasise the importance of rapid diagnosis and prompt treatment in such cases.
Highlights
An 87-year-old man presented to his general practitioner (GP) with neck pain that had been worsening for several weeks
The patient was admitted to hospital immediately and further imaging was performed with computed tomography (CT)
This showed that atlantoaxial instability had developed due to bony destruction and fracture of the odontoid peg, with an increase in the atlanto–dens interval and a corresponding decrease in spinal canal diameter (Fig 3)
Summary
An 87-year-old man presented to his general practitioner (GP) with neck pain that had been worsening for several weeks. He was generally well but had been treated with a course of antibiotics for a urinary tract infection approximately one week before the onset of his symptoms His GP arranged plain x-rays of the cervical spine, which were performed three weeks after the initial presentation. The patient was admitted to hospital immediately and further imaging was performed with computed tomography (CT) This showed that atlantoaxial instability had developed due to bony destruction and fracture of the odontoid peg, with an increase in the atlanto–dens interval and a corresponding decrease in spinal canal diameter (Fig 3). The patient was transferred urgently for specialised intervention and he underwent posterior spinal decompression and instrumented occipitocervical fusion (Fig 4), needing a temporary tracheostomy He made a satisfactory recovery, mobilising independently with normal gait, but required a prolonged period of rehabilitation
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