LAUSR

Studies about pediatric pyogenic osteomyelitis have been conducted. However, most reports have only included a limited number of cervical spine cases and data about lumbar spine onset. The current treatment method for pediatric pyogenic osteomyelitis of the cervical spine, which includes treatment selection for patients who require drainage and the fixation method with the use of a cervical collar or cast or with surgery, is controversial. Herein, we present a child with pyogenic osteomyelitis of the upper cervical spine with destruction at the odontoid process of the axis. A 6-year-old girl with no significant medical history had flu-like symptoms 2 weeks prior to onset. The symptoms spontaneously improved. Then, she presented with fever (temperature, 37°C-38°C) and severe neck pain without neurological symptoms in the four limbs. The symptoms exacerbated; thus, she sought consultation at a local clinic 1 week after onset. Cervical computed tomography scans revealed a retropharyngeal abscess and osteolysis of the axis. Cervical magnetic resonance imaging revealed intensity changes in the atlas and axis and formation of a retropharyngeal abscess (Fig. 1). Blood testing revealed a white blood cell count of 10.8 × 10/L and a C-reactive protein (CRP) level of 19.6 mg/L, which is indicative of an inflammatory reaction. Meropenem intravenous infusion (120 mg/ kg/day) was initiated; subsequently, the CRP level rapidly decreased. However, after 1 week, the patient’s neck was rotated to the left side due to continuous pain. Computed tomography revealed osteolysis at the base of the odontoid process of the axis (Fig. 2). The pain could not be controlled with a cervical collar; therefore, a halo vest was used. Fluoroscopic imaging revealed instability at the base of the odontoid process caused by posterior compression of the neck. In the recumbent position, the vertebra of the axis was displaced posterior to the odontoid process. The patient experienced severe neck pain when changing from the sitting position to the recumbent position. By providing support using a stretching band from the rear to the mid-tolower cervical spine, neck pain during movement was alleviated (Fig. 3). After 1 month, meropenem intravenous infusion was changed to oral cephalexin at a dose of 2,000 mg/ day. Bone healing of the axis was confirmed on cervical computed tomography scans performed after 2 months; thus, the halo vest was removed. After 3 months, oral antibiotic therapy was discontinued, and neck pain or recurrence of inflammation was not observed after 2 years (Fig. 4). The major cause of cervical vertebral osteomyelitis is the spread of a retropharyngeal abscess, which can be treated with surgical drainage and antibiotic therapy; however, treatment with antibiotics alone has also been reported. Nonsurgical treatment can be considered in some patients with a small-sized retropharyngeal abscess. Our patient had a small abscess and showed an improved reaction during the early stage of treatment; therefore, she could be treated with antibiotic therapy alone. As previously indicated, surgical treatment is required in patients with a large abscess owing to serious complications, including airway obstruction, or