Finn Michael, Fassett Daniel R, Apfelbaum Ronald I
Department of Neurosurgery, University of Utah, Salt Lake City, UT 84132, USA.
Spine (Phila Pa 1976). 2007 Dec 15;32(26):3067-73. doi: 10.1097/BRS.0b013e31815d004c.
A retrospective review.
The purpose of this study was to evaluate the clinical and pathologic findings and surgical treatment outcomes for atlantoaxial osteoarthritis.
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.
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.
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.
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.
一项回顾性研究。
本研究旨在评估寰枢椎骨关节炎的临床和病理表现以及手术治疗效果。
非类风湿性寰枢椎骨关节炎性退变可发生于寰齿关节或侧块关节。这种情况可能在压迫性退变血管翳的情况下出现颈部疼痛或脊髓病。关于这个主题的文献很少，只有病例报告和小病例系列。
进行回顾性病历审查以确定接受C1-C2骨关节炎治疗的患者。记录每位患者的人口统计学资料、临床表现、神经学检查、视觉模拟疼痛评分、影像学表现、手术治疗、结果和并发症。
26例患者（18例寰齿关节有血管翳，8例主要为侧块关节关节炎；男性10例，女性16例；平均年龄74岁）接受了寰枢椎骨关节炎的手术治疗。11例患者主要表现为与脊髓病相关的症状（均有退变血管翳），15例仅表现为颈部疼痛。所有患者均接受了寰枢椎后路融合术，13例因不可复位半脱位导致脊髓病或严重椎管狭窄的患者还接受了经口齿状突切除术。所有脊髓病患者的神经功能均有改善（11例中有10例改善了1个Ranawat分级）。术前有颈部疼痛主诉的患者中，93%的患者颈部疼痛得到改善（术前平均视觉模拟评分为7.0，随访时为1.3）。所有接受充分随访的患者均显示融合成功。
寰枢椎骨关节炎可导致颈部疼痛和脊髓病。在存在退变血管翳和脊髓病的情况下，大多数患者经口减压和融合术后神经功能会改善。仅有血管翳而无脊髓病的患者单纯后路融合术治疗有效，尽管2例不可复位半脱位患者在融合前需要先进行经口减压以实现复位。单纯后路融合术在大多数患者中提供了显著的疼痛缓解。
