Pyogenic osteomyelitis rarely affects the first and second cervical
vertebrae, and when it does it can progress to abscess formation,
compressing the spinal cord. If the process is unrecognized, it can be
fatal. The cases of five patients are reported. Two patients were treated
by anterior debridement and posterior cervical-occipital arthrodesis; one,
by transoral drainage; one, by posterior cervical-occipital arthrodesis;
and the fifth, by posterior atlanto-axial arthrodesis. The causative
organism was Staphylococcus aureus in four patients and Pasteurella
multocida in one. In all patients, intravenous antibiotics were used,
followed by prolonged administration of oral antibiotics. All five patients
recovered.