Muscal Eyal, Satyan Krishna B, Jea Andrew
Neuro-Spine Program, Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
J Med Case Rep. 2011 Jul 3;5:275. doi: 10.1186/1752-1947-5-275.
Atlantoaxial instability has been described as a manifestation of ankylosing spondylitis (juvenile and adult onset), reactive arthritis, juvenile idiopathic arthritis, and rheumatoid arthritis; however, it has rarely been reported as an early manifestation of these disorders. We present this case report to increase awareness of the condition in the hope that earlier recognition of this disease may prevent further serious injury.
We report the case of a 17-year-old Hispanic adolescent woman who was initially diagnosed with undifferentiated spondyloarthritis due to peripheral arthritis, enthesitis, a positive human leukocyte antigen B27 result, and inflammatory spinal pain lasting two months. Our patient experienced persistent and worsening occipitocervical pain and signs of myelopathy three months after diagnosis; consequently, we found atlantoaxial instability along with cervical spine bone erosion and pannus formation. She was treated surgically with a C1-2 posterior instrumented fusion and at six weeks post-operatively was started on tumor necrosis factor α blockade. Her occipitocervical symptoms subsided following surgery and initiation of immunomodulation.
Our report serves to emphasize to pediatric and adult general practitioners, pediatricians, internists, family physicians, pediatric and adult rheumatologists and spine surgeons that atlantoaxial subluxation may be an early manifestation of spondyloarthritis, and that the condition is treatable by surgical intervention and immunomodulation.
寰枢椎不稳已被描述为强直性脊柱炎（青少年和成人发病型）、反应性关节炎、青少年特发性关节炎和类风湿关节炎的一种表现；然而，它作为这些疾病的早期表现却鲜有报道。我们呈现此病例报告以提高对该病症的认识，希望能更早地识别此病，从而预防进一步的严重损伤。
我们报告一名17岁西班牙裔青少年女性的病例，她最初因外周关节炎、附着点炎、人类白细胞抗原B27结果呈阳性以及持续两个月的炎性脊柱疼痛而被诊断为未分化脊柱关节炎。诊断三个月后，我们的患者出现持续且加重的枕颈疼痛和脊髓病体征；因此，我们发现了寰枢椎不稳以及颈椎骨质侵蚀和血管翳形成。她接受了C1 - 2后路器械融合手术治疗，术后六周开始使用肿瘤坏死因子α阻滞剂。手术及启动免疫调节治疗后，她的枕颈症状消退。
我们的报告旨在向儿科和成人全科医生、儿科医生、内科医生、家庭医生、儿科和成人风湿病学家以及脊柱外科医生强调，寰枢椎半脱位可能是脊柱关节炎的早期表现，并且该病症可通过手术干预和免疫调节进行治疗。
