Osteomyelitis of Cervical Spine

Piran Aliabadi, MD
B Leonard Holman, MD

November 8, 1995

Presentation

A 70-year-old man presents with fever and flank pain. Laboratory work-up shows evidence of a urinary tract infection (Escherichia coli) and the patient is treated for the infection. During treatment he develops mild neck pain. Neurologic examination is normal.

Imaging Findings

Plain radiograph of cervical spine

Second radiograph of cervical spine

Bone scintigraphy

Gallium scintigraphy

Sagittal and axial MRI of the cervical spine

Degenerative disc disease is visible in the mid and lower cervical spine (arrows). Prevertebral soft tissues appear normal.

Three weeks later, while the patient is still being treated with antibiotic for urinary tract infection, the neck pain becomes more severe and the patient has difficulty swallowing. Neurologic examination is normal.

A second radiograph of the cervical spine shows marked prevertebral soft tissue swelling in the lower cervical region (arrow).

Bone scintigraphy shows increased uptake in the lower cervical region (arrow), which could be due to osteomyelitis or degenerative disc disease. Gallium scintigraphy shows increased uptake in the lower cervical region (arrow), which is more intense than the uptake on the bone scan, indicating cervical spine osteomyelitis.

The patient is treated vigorously for osteomyelitis E coli . The swallowing function returns to normal and neck pain decreases. However, four weeks into the treatment the patient develops a neurologic finding related to the lower cervical cord region.

Sagittal proton density and T2 images of the cervical spine show marked narrowing of C6-7 disc space with destruction of the cortices of the C6 and 7 vertebrae at the same level. Abnormal signals in the vertebral bodies and soft tissues become bright on the T2 image (arrows), consistent with osteomyelitis. Axial proton density and T2 images show a collection of fluid with surrounding low signal intensity consistent with an epidural abscess compressing the cervical spinal cord on the right side at the C6-7 level (arrows).

Diagnosis

Osteomyelitis

Discussion

Work-up for suspected osteomyelitis: The first step is to obtain plain radiographs of the involved area. If osteomyelitis is diagnosed, no additional imaging is required. If osteomyelitis is suspected and the radiograph is normal, bone/gallium-67 or bone/WBC scintigraphy is the next step. If osteomyelitis is diagnosed, no additional imaging is needed. In cases where osteomyelitis is suspected and the plain radiographs and scintigrams are not diagnostic (or with neurological segur), MRI or CT may be indicated. Do CT when looking for sequestrum. Do MRI for bone and soft tissue involvement and extent, and/or for suspected spinal cord compression.

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