Conservative management of pyogenic osteomyelitis of the occipitocervical junction

Study Design. A report of three cases of pyogenic osteomyelitis of the occi pitocervical junction. Objective. To describe the conservative management of pyogenic osteomyeliti s of the occipitocervical junction. Summary of Background Data. The therapeutic approach to inflammation of the upper cervical spine is controversial. Methods. Pyogenic osteomyelitis of the occipitocervical junction is rare. I n the orthopedic literature, only a few case reports with variable treatmen t methods are available. Three patients with pyogenic osteomyelitis of the occipitocervical junction were treated nonoperatively. Intravenous antibiot ic therapy was begun after direct cultures or blood cultures were obtained. Early mobilization was accomplished by application of a halo vest. Results. Two patients recovered by spontaneous fusion of the occipitocervic al junction. Instability developed in the spine of one patient, but she ref used further treatment. Conclusions. Diagnosis of osteomyelitis of the upper cervical spine is diff icult. In cases with absence of neurologic symptoms or spinal abscess forma tion, treatment can be nonoperative.