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Introduction   Neonatal vertebral osteomyelitis is not an uncommon condition, but osteomyelitis simultaneously involving the atlas and the axis is distinctly unusual and no other infant case has been published so far in the literature. We present the case of an infant with retropharyngeal abscess, which led to the destruction of the C1–C2 vertebrae.Materials and Methods   MRI examination revealed a multilocular abscess in the right mastoidal area penetrating to the cervical region and causing destruction of the C1 and C2 vertebrae, and an epidural abscess with signs of spinal cord compression at the level of the Th5–Th7 vertebrae. The retropharyngeal and thoracic abscesses were surgically removed and the therapy was completed with antibiotics. The child was placed in a custom-made fixation device for 8 weeks. Follow-up was performed with MRI, CT scans, and functional X-ray diagnostics.Results   CT scans with 3D reconstruction demonstrated the absence of normal osseous structures at the craniospinal region, but undamaged ossification centers in the C3 vertebra and below. Functional X-ray diagnostics, performed in general anesthesia showed no significant instability of the cervical spine. Normal motor development and independent walking were allowed. During a 4-year long follow-up period, no signs of neurological impairment were observed, neck movements were limited but painless. It is assumed that the remnants of the bony elements of C1–C2 vertebrae and the massive interconnecting postinflammatory scar tissue make some degree of neck movements possible. His development was undisturbed, similar to his age group.Conclusion   C1–C2 osteomyelitis is a very rare entity even in children. There is limited experience with treatment and rehabilitation, but the temporary immobilization of the neck, surgical debridement, antibiotic treatment, and continuous physiotherapy can be recommended. Close follow-up is required to check the reconstitution of affected bones and ligaments, any development of instability, and the necessity of surgical stabilization.

Osteomyelitis and Destruction of the Atlas and Axis in a 4-Week-Old Infant: 4-Year Follow-Up