PMC5994273_01
Axial MRI slice at initial presentation: contrast-enhanced T1-weighted axial MRI scan at the level of the dens axis. The white arrow identifies an annular enhancement round the dens axis while the white asterisk indicates the focus ventromedial of the left arch of the Atlas with 11 x 8 mm in diameter.
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Further, the dens axis displayed a small circular enhancement that caused a slight compression of the dural sac without significant myelon compression (Figure 1).
Axial MRI slice five days after incision and drainage of the prevertebral abscess: contrast-enhanced T1-weighted axial MRI scan shows the incised abscess cavity (white asterisk) which is connected to a progressive fluid retention especially in the area between the dorsal ligament and the ventral dura with a slight compression of the myelon (white arrow). This epidural abscess ranged from the foramen magnum to the upper ridge of the third cervical vertebra.
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The follow-up MRI, five days after the initial diagnosis, displayed a significant progression in terms of a paravertebral and intraspinal abscess formation in the upper cervical spine (Figure 2).
Lateral X-ray of the neck after dorsal stabilisation. The inserted devices are in correct position in all plains.
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Eight days after the odontoid resection, the infection parameters returned to nearly normal values (CRP 1.8 U/ml and leucocytes 7.200/microl), and posterior C1-C2-instrumentated fusion was performed (Summit , DePuy) to restore craniocervial stability (Figure 3).