Neck pain can be caused by infections. This includes two infectious processes, osteomyelitis and discitis.
With discitis the infection is often in children aged 4 to 10 and there is little systemic evidence of an infection. These children complain of a stiff spine, which they do not want to bend.
Blood tests show often a normal white blood cell count, but an increase in the sedimentation rate (ESR). X-rays show a narrowed disc space, which in childhood is unheard of. A technetium bone scan shows uptake at the affected disc space. An MRI scan shows changes of discitis earlier (thanks to www.sciencephoto.com for this image) than the bone scan, as it is more sensitive. The image shown on this colored MRI scan depicts an infectious discitis at the C2/3 level. The inflamed disc is putting pressure against the spinal cord (shown in green), where there is a spinal stenosis and this causes intense pain. The causative organism os mostly Staphylococcus aureus , a common pus producing bug. Occasionally tuberculosis can be isolated. Treatment is with antibiotics intravenously first and then orally for a prolonged period of time.
Osteomyelitis of the neck
Osteomyelitis of the cervical spine may initially start quite slowly, but eventually gains momentum and leads to a generally sick patient. Fever, spinal pain and often neurological deficits from a pinched nerve (nerve root compression) are common. Particularly in elderly patients who seem to be more at risk of getting this illness there are often concomitant other illnesses such as diabetes mellitus, rheumatoid arthritis, steroid treatment (for other illnesses) and staphylococcus infections elsewhere in the body.
In this patient group the immune system is weakened and this predisposes them to getting osteomyelitis. Gun shot wounds put a person at a high risk for getting osteomyelitis and a thorough work-up is indicated. Patients with pneumonia or urinary tract infections and IV drug users have a higher chance of getting osteomyelitis of the spine. Gallium bone scan testing will localize the infection. As there is a higher risk for serious permanent neurological damage, an open biopsy with bone sample removal for culturing is often necessary.
Staphylococcus aureus infection is common. In drug addict more rare conditions such as brucellosis, tuberculosis, candidiasis and coccidiomycosis are fairly common. Here is an MRI scan of the cervical spine of a patient with osteomyelitis. She is in her 40’s and has osteomyelitis in her mid cervical spine. One can see how there is pressure of the enlarged vertebral body exerting onto the spinal cord at this level. Treatment is modified according to the culture reports and the clinical response to antibiotics.
The bone structure of the vertebral bodies of the cervical spine can be changed due to general metabolic changes that lead to osteoporosis or osteomalacia. For instance with rickets in childhood or with osteomalacia in adults the underlying common denominator is a vitamin D deficiency. This leads in turn to a lack of calcium absorption in the intestinal canal. Without calcium there is insufficient bone formation and mineralization. Osteoporosis results when in postmenopausal women there is a lack of estrogens. But men with andropause also can get osteoporosis and int them it is because of a lack of testosterone.
References
1. ABC of rheumatology, second edition, edited by Michael L. Snaith , M.D., BMJ Books, 1999. Chapter 2.
2. D Irnich et al. BMJ 2001 Jun 30;322(7302):1574.
3. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 140.
4. Goldman: Cecil Textbook of Medicine, 21st ed.(©2000)W.B.Saunders
5. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
6. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier
7. Suzanne Somers: “Breakthrough” Eight Steps to Wellness– Life-altering Secrets from Today’s Cutting-edge Doctors”, Crown Publishers, 2008
