Discussion
The atlantoaxial joint is compounded of three synovial joints: the
median joint (atlanto-odontoid joint) and two lateral joints (facet
joints).
Atlantoaxial septic arthritis is scarce. To our knowledge, only 2 cases
of atlanto-odontoid arthritis have been reported in the literature
[1,2].
Clinical presentation can include neck pain, fever, paravertebral muscle
contracture, and restricted neck movement. Inflammatory markers are
often increased. Nevertheless, they were within the normal limit in a
case of septic arthritis of the facet joint [3].
MRI allows an early diagnosis of synovitis of atlanto-odontoid joint. In
this stage, different diagnoses may be discussed such as cervical spine
crystal deposition, rheumatic inflammatory diseases especially
rheumatoid arthritis, and infectious atlanto-odontoid arthritis. At a
late stage, MRI can show epidural collection, abscess, and spinal
compression. In our case, the presence of epidural collection led to the
diagnosis of a septic atlanto-odontoid joint.
The identification of the bacterial agent is sometimes difficult.
Staphylococcus aureus is the most causative agent in septic cervical
arthritis [1].
Although the presence of epidural collection in our case, the
conservative treatment led to clinical and imaging improvement of the
septic atlanto-odontoid joint. Septic arthritis C1-C2 can be responsible
for serious complications such as neurological compression and cerebral
thrombosis. [4] In our case, internal venous thrombosis was due to
neck abscess. Signs and symptoms
of internal venous thrombosis can associate swelling and sensitivity
along the front edge of the sternocleidomastoid muscle [5].