Transoral anterior approach for extensive anterior decompression at the C3 vertebra level in a patient with severe atlantoaxial vertical subluxation and rheumatoid arthritis.
METHODS
We report a successful extensive transoral anterior decompression for an elderly patient with myelopathy and occipitalgia due to severe atlantoaxial vertical subluxation and posterior subluxation of the axis associated with rheumatoid arthritis (RA).


OBJECTIVE
To describe the treatment of an exceptional pathological condition involving severe vertical subluxation.


METHODS
University-affiliated hospital in Gifu, Japan.


METHODS
A 73-year-old woman was referred to our clinic because of myelopathy and occipitalgia due to severe atlantoaxial vertical subluxation and posterior subluxation of the axis associated with RA. Plain radiographs revealed severe atlantoaxial vertical subluxation and sagittal magnetic resonance (MR) imaging revealed severe compression of the spinal cord at the level of the C2/3 disc space due to both posterior subluxation of C2 and rheumatoid pannus at the C2/3 disc space. As MR images demonstrated that the C2/3 disc space was located just behind the retropharyngeal wall, we performed successful anterior decompression from C2 to C3 via the standard transoral approach without mandibular osteotomy.


RESULTS
The patient has been followed for 4 years and her symptoms are currently much improved without further surgical treatment.


CONCLUSIONS
The present case illustrates that severe atlantoaxial vertical subluxation and posterior subluxation of the axis associated with RA can be treated successfully by anterior decompression of C2 and C3 via the standard transoral approach.
Sasaki
T
T
Department of Orthopaedic Surgery, Gifu University School of Medicine, Gifu, Japan.
Miyamoto
K
K
Hosoe
H
H
Shimizu
K
K
D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000150:complications / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D013117:Spinal Cord Compression / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013131:Spine / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed