Transarticular screw fixation for osteoarthritis of the atlanto axial segment.
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Atlantoaxial (C1-C2) facet joint osteoarthitis is a distinct clinical syndrome that often goes unrecognized. Severe pain resistant to conservative treatment that is corroborated by the radiographic findings represents the indication for surgery. The aim of this study was to retrospectively examine the long-term outcome [after an average 6.5 years (SD 4.0)] of C1-2 fusion for osteoarthritis of the atlantoaxial segment in 35 consecutive patients [25 male, 10 female; aged 62 (SD 15) years]. At follow-up, clinical outcome and radiological status was examined in 27/35 (77%) patients, and self-rated pain and disability (Neck Pain and Disability Scale; NPDS) in 29/35 (83%) patients. In 27/35 patients (77%), 2 screws were inserted; in 7 patients (20%), only 1 screw; and in 1 patient (3%), no screws. 11% of the patients had late complications requiring revision surgery. All patients showed solid fusion at the long-term follow-up. 26% patients showed an improvement in sensory disturbances, 63% no change, and 11% a worsening. 89% were pain-free or had markedly reduced pain. The average score on the NPDS (0-100) was 34 (SD 27), representing 'mild' neck problems, and the average pain intensity (0-5 VAS) was 1.5 (SD 1.5). Eighty-five percent of the patients declared that they would make the same decision again to undergo surgery. In conclusion, in a group of patients with a painful and debilitating degenerative disorder of C1-2, posterior transarticular atlantoaxial fusion proved to be an effective treatment with a low rate of serious complications. (+info)
Results after 24 years of prophylactic surgery for rheumatoid atlantoaxial subluxation.
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We evaluated the use of surgical stabilisation for atlantoaxial subluxation after a follow-up of 24 years in 50 rheumatoid patients who had some degree of pain but no major neurological deficit. The mortality of patients treated by atlantoaxial fusion was significantly lower than for those who received conservative treatment. The deaths resulted from infection or comorbid conditions. The significantly high relative risks of mortality from conservative treatment compared with surgical treatment were mutilating disease and susceptible factors on both of the HLA-DRB1 alleles. Relief from pain and neurological and functional recovery were better, and the radiological degree of atlantoaxial translocation was less in those who were surgically treated compared with those who were not. Two patients had superficial local infections after surgery. We conclude that prophylactic atlantoaxial fusion is better than conservative treatment in these patients. (+info)
Atlantoaxial joint distraction for treatment of basilar invagination secondary to rheumatoid arthritis.
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We present our experience of treating two cases of rheumatoid arthritis involving the craniovertebral junction and having marked basilar invagination by an alternative treatment method. In both the cases, the facets were osteoporotic and were not suitable for screw implantation. The patients were 66 and 72 years of age and both patients were females. Both the patients presented with complaints of progressively increasing spastic quadriparesis. Surgery involved attempts to reduce the basilar invagination and restore the height of the 'collapsed' lateral mass by manual distraction of the facets of the atlas and axis and forced impaction of titanium spacers in the joint in addition to bone graft harvested from the iliac crest. The procedure also provided stabilization of the region. No other fixation procedure involving wires, screws, plate and rods was carried out simultaneously. Following surgery both the patients showed symptomatic improvement and partial restoration of craniovertebral alignments. Follow-up is of 2 and 24 months. Distraction of the facets of atlas and axis and impaction of metal implant and bone graft in the facet joint can assist in reduction of basilar invagination and fixation of the region in selected cases of rheumatoid arthritis involving the craniovertebral junction. (+info)
Odontoid lateral mass asymmetry: do we over-investigate?
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OBJECTIVES: This study aimed to evaluate the necessity for further radiological investigation in patients with suspected traumatic rotatory subluxation of the atlanto-axial complex on plain radiography following acute cervical trauma and outline guidelines for assessment of patients with atlanto-axial asymmetry on plain radiography. METHODS: A retrospective review of all patients who had undergone atlanto-axial CT scanning as a result of radiographic C1-C2 asymmetry following cervical spine trauma. The plain x ray and CT images were reviewed retrospectively and correlated with the clinical presentation and outcome. RESULTS AND CONCLUSION: Records of 29 patients (16 men, 13 women; age range 21-44 years) were reviewed. All patients were found to have atlanto-odontoid asymmetry on the initial plain x ray. CT images of none of the patients revealed rotatory subluxation. Ten patients (32%) were found to have congenital odontoid lateral mass asymmetry. All patients were treated conservatively without any further intervention. On review, in 19 patients the orientation of the x ray beam in combination with head rotation was found to be at fault. Approximately 1050 trauma cervical spine x rays were taken in the department where this study was conducted over the period 1999-2001. This study identified 10 patients out of a total of 29 as having congenital odontoid lateral mass asymmetry. This represents approximately 1% of the patients attending the emergency department. Thus congenital odontoid lateral mass asymmetry should be considered in the differential diagnosis following acute cervical trauma. (+info)
Atlantoaxial rotatory subluxation should be considered in the presentation of traumatic torticollis. This case report discusses the characteristic radiographic findings and appropriate management. (+info)
Tophaceous gout causing atlanto-axial subluxation mimicking rheumatoid arthritis: a case report.
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This is a case report of an extremely rare condition of atlanto-axial subluxation secondary to gouty arthritis, which mimicked rheumatoid arthritis at presentation. Gouty arthritis involving the spine is a rare condition. We highlight a case of gouty arthritis involving the atlanto-axial joint resulting in joint instability, subluxation, and neurological deficit. A 66-year-old obese woman who had a polyarticular disease for the previous 3 years presented with neck pain and progressive neurology. A 2-stage procedure was performed: posterior decompression and occipitocervical fusion followed by further anterior trans-oral decompression. However, after an initial neurological improvement, she succumbed to aspirational pneumonia and septicaemia. Atlanto-axial subluxation caused by gouty arthritis can present in the same way as rheumatoid arthritis. Therefore, the possibility of this as a differential diagnosis should be kept in mind. (+info)
Craniovertebral junction realignment for the treatment of basilar invagination with syringomyelia: preliminary report of 12 cases.
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Twelve selected patients, eight males and four females aged 14 to 50 years, with syringomyelia associated with congenital craniovertebral bony anomalies including basilar invagination and fixed atlantoaxial dislocation, and associated Chiari I malformation in eight, were treated by atlantoaxial joint manipulation and restoration of the craniovertebral region alignment between October 2002 and March 2004. Three patients had a history of trauma prior to the onset of symptoms. Spastic quadriparesis and ataxia were the most prominent symptoms. The mean duration of symptoms was 11 months. The atlantoaxial dislocation and basilar invagination were reduced by manual distraction of the facets of the atlas and axis, stabilization by placement of bone graft and metal spacers within the joint, and direct atlantoaxial fixation using an inter-articular plate and screw method technique. Following surgery all patients showed symptomatic improvement and restoration of craniovertebral alignment during follow up from 3 to 20 months (mean 7 months). Radiological improvement of the syrinx could not be evaluated as stainless steel metal plates, screws, and spacers were used for fixation. Manipulation of the atlantoaxial joints and restoring the anatomical craniovertebral alignments in selected cases of syringomyelia leads to remarkable and sustained clinical recovery, and is probably the optimum surgical treatment. (+info)
High prevalence of asymptomatic cervical spine subluxation in patients with rheumatoid arthritis waiting for orthopaedic surgery.
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OBJECTIVE: To study the prevalence of cervical spine subluxation in patients with rheumatoid arthritis waiting for orthopaedic surgery, and symptoms that might be associated with the disorders. METHODS: 194 patients with rheumatoid arthritis were referred for orthopaedic surgery at Jyvaskyla Central Hospital, 154 (79%) of whom volunteered for the present study including clinical examination, laboratory tests, radiographs of the cervical spine, hands, and feet, and self report questionnaires. Definition of anterior atlantoaxial subluxation (aAAS) was >3 mm and of subaxial subluxation (SAS)>or=3 mm. Atlantoaxial impaction (AAI) was analysed following to the Sakaguchi-Kauppi method. RESULTS: 67 patients (44%) had cervical spine subluxation or previous surgical fusion. The prevalence of aAAS, AAI, SAS, or previous fusion was 27 (18%), 24 (16%), 29 (19%), and 8 (5%), respectively; 69% of patients with cervical spine subluxations (those with fusions excluded) reported neck pain, compared with 65% of patients without subluxations (p=0.71). The prevalence of occipital, temporal, retro-orbital, and radicular pain in upper extremities was similar in patients with or without cervical spine subluxations (54% v 43%; 17% v 31%; 25% v 24%; 47% v 48%, respectively). However, patients with subluxations were older, had longer disease duration, more active disease, poorer function according to the Health Assessment Questionnaire, and had more often erosive disease. CONCLUSIONS: Asymptomatic cervical spine subluxation is common in patients with rheumatoid arthritis waiting for orthopaedic surgery. Regardless of symptoms, the possibility of cervical spine subluxation in patients with severe rheumatoid arthritis should be considered in preoperative evaluation. (+info)