Atlantoaxial instability secondary to Bartonella henselae osteomyelitis managed surgically by atlantoaxial instrumentation: A case report and systematic review

Mansour Mathkour; Julie Chu; Tyler Scullen; Naser Ibrahim; Cassidy Werner; Christopher J Carr; Brendan Huang; Hussam Abou-Al-Shaar; Robert F Dallapiazza; Christopher M Maulucci; Manish Singh

doi:10.4103/jcvjs.jcvjs_206_20

Atlantoaxial instability secondary to Bartonella henselae osteomyelitis managed surgically by atlantoaxial instrumentation: A case report and systematic review

J Craniovertebr Junction Spine. 2022 Jul-Sep;13(3):224-232. doi: 10.4103/jcvjs.jcvjs_206_20. Epub 2022 Sep 14.

Authors

Mansour Mathkour^{1

2

3}, Julie Chu¹, Tyler Scullen^{1

2}, Naser Ibrahim^{1

2}, Cassidy Werner¹, Christopher J Carr¹, Brendan Huang¹, Hussam Abou-Al-Shaar⁴, Robert F Dallapiazza^{1

2}, Christopher M Maulucci^{1

2}, Manish Singh^{1

5}

Affiliations

¹ Department of Neurological Surgery, Tulane Medical Center, New Orleans, LA, USA.
² Department of Neurological Surgery, Ochsner Clinic Foundation, Ochsner Health System, New Orleans, LA, USA.
³ Department of Surgery, Neurosurgery Division, Jazan University, Jazan, Saudi Arabia.
⁴ Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
⁵ Department of Neurosurgery, Southern Brain and Spine, Metairie, LA, USA.

Abstract

Cat scratch disease (CSD), caused by Bartonella henselae, may atypically present with vertebral osteomyelitis. Antibiotic regimens are tailored to presentation, which is markedly variable and not well defined for any atypical disease. In cases of spinal instability, the use of antibiotics alone may not be sufficient. Atlantoaxial instability caused by osteomyelitis is a rare complication of CSD. In this report, we describe the rare case of vertebral osteomyelitis complicated by atlantoaxial instability, requiring both antibiotics and atlantoaxial fusion. We discuss our case, surgical technique, rationale, and outcome. In addition, we conducted a systematic review of the literature of vertebral osteomyelitis in pediatric secondary to B. henselae. A 2-year-old child presented with a 2-month history of irritability, fever, and rigid neck pain along with a recent history of feline exposure. Physical examination revealed cervical tenderness and decreased range of motion. Computed tomography (CT) showed osteolysis of the right C1 lateral mass and pars articularis; T1-weighted magnetic resonance imaging with contrast showed enhancement around the right C1 lateral mass. The titer for B. henselae was high. A diagnosis of cat scratch osteomyelitis with cervical instability was made, for which the patient underwent surgery with atlantoaxial fusion. Postoperative imaging demonstrated resolution of the contrast-enhanced lesion. At 6-year follow-up, the patient showed no signs of residual complications from surgical intervention with a solid fusion. Our review revealed 44 cases of pediatric CSD vertebral osteomyelitis. Conservative management with antibiotic employed in 86% while antibiotics with surgical intervention in 14% of the cases. Surgical intervention was most often in the form of incision for drainage and decompression without fusion. Average follow-up 10 months with 86% achieved complete resolution. Cervical instability caused by osteolysis is a rare complication of CSD. This can subsequently lead to vertebral instability, requiring definitive surgical intervention.

Keywords: Atlantoaxial instability; Bartonella henselae; cat scratch disease; cervical instrumentation; cervical osteomyelitis.

Publication types

Review