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Atlantoaxial instability secondary to Bartonella henselae osteomyelitis managed surgically by atlantoaxial instrumentation: A case report and systematic review
Mansour Mathkour1, Julie Chu2, Tyler Scullen3, Naser Ibrahim3, Cassidy Werner2, Christopher J Carr2, Brendan Huang2, Hussam Abou-Al-Shaar4, Robert F Dallapiazza3, Christopher M Maulucci3, Manish Singh5
1 Department of Neurological Surgery, Tulane Medical Center; Department of Neurological Surgery, Ochsner Clinic Foundation, Ochsner Health System, New Orleans, LA, USA; Department of Surgery, Neurosurgery Division, Jazan University, Jazan, Saudi Arabia
2 Department of Neurological Surgery, Tulane Medical Center, New Orleans, LA, USA
3 Department of Neurological Surgery, Tulane Medical Center; Department of Neurological Surgery, Ochsner Clinic Foundation, Ochsner Health System, New Orleans, LA, USA
4 Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
5 Department of Neurological Surgery, Tulane Medical Center, New Orleans; Department of Neurosurgery, Southern Brain and Spine, Metairie, LA, USA
Correspondence Address:
Mansour Mathkour
Department of Neurosurgery, Tulane University Medical Center, 1415 Tulane Ave, New Orleans, LA 70112, USA
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jcvjs.jcvjs_206_20
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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.
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