Surgical treatment of nonrheumatoid atlantoaxial degenerative arthritis producing pain and myelopathy.

STUDY DESIGN

A retrospective review.

OBJECTIVE

The purpose of this study was to evaluate the clinical and pathologic findings and surgical treatment outcomes for atlantoaxial osteoarthritis.

SUMMARY OF BACKGROUND DATA

Nonrheumatoid atlantoaxial osteoarthritic degeneration can occur at either the atlantodental articulation or lateral mass articulations. This condition may present with neck pain or myelopathy in the setting of a compressive degenerative pannus. There is a paucity of literature on this topic with only case reports and small case series.

METHODS

A retrospective chart review was performed to identify patients treated for C1-C2 osteoarthritis. Patient demographics, clinical presentation, neurologic examination, visual analog pain scores, radiographic findings, surgical treatment, outcomes, and complications were recorded for each patient.

RESULTS

Twenty-six patients (18 with pannus at the atlantodental articulation and 8 primarily with lateral mass articulation arthritis; 10 men, 16 women; mean age 74 years) were surgically treated for atlantoaxial osteoarthritis. Eleven patients presented primarily with complaints related to myelopathy (all with a degenerative pannus) and 15 presented with cervicalgia only. All patients were treated with posterior atlantoaxial arthrodesis, and 13 patients with myelopathy or severe canal compromise from an irreducible subluxation also had transoral odontoidectomy. All myelopathic patients had improvement in neurologic function (10 of 11 improved 1 Ranawat grade). Neck pain improved in 93% of patients with preoperative neck pain complaints (mean visual analog score before surgery = 7.0, follow-up = 1.3). Fusion was demonstrated in all patients with adequate follow-up.

CONCLUSION

Atlantoaxial osteoarthritis can result in neck pain and myelopathy. In the setting of a degenerative pannus and myelopathy, most patients will improve neurologically after transoral decompression and arthrodesis. Patients with pannus and no myelopathy were effectively treated with posterior fusion alone, although 2 with irreducible subluxation required an initial transoral decompression to allow realignment before fusion. Posterior arthrodesis alone provided significant pain relief in most patients.