title: Management of recalcitrant osteoarthritis of the atlanto-axial joint.
abstract: The medical records and radiographs of 17 patients with recalcitrant pain secondary to C1-C2 osteoarthritis were independently reviewed. All patients were treated by the senior author (K.D.R.). Initial treatment included physical therapy, nonsteroidal anti-inflammatory drugs, and soft collar immobilization. If non-responsive, patients were referred to a single radiologist for injection of the involved C1-C2 joint(s). If symptoms persisted, then transarticular screw fixation and Magerl wire fixation with structural iliac crest bone graft was performed. Postoperatively, all patients were placed in a soft collar. Postoperative anteroposterior (AP), lateral, flexion/extension, and open-mouthed odontoid radiographs were taken at 6 weeks, 3 months, and 1 year. Three independent observers assessed all radiographs for fusion. Fusion was noted by radiographic evidence of bridging bony trabeculae across the C1-C2 joint and/or bridging bone from the posterior arch of C1 to the C2 spinous process. Patient satisfaction improved significantly whether they were treated by corticosteroid injection or surgically.
authors.affiliation: Walter Reed Army Medical Center, Dept of Orthopedic Surgery and Rehabilitation, 6900 Georgia Ave, NW Washington, DC 20307-5001, USA.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Kuklo
authors.forename: K Daniel
authors.initials: KD
authors.lastname: Riew
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Orchowski
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Won
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Schroeder
authors.forename: Louis A
authors.initials: LA
authors.lastname: Gilula
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D001268:Atlanto-Axial Joint / Q000187:drug effects / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D019547:Neck Pain / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D010003:Osteoarthritis / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D017060:Patient Satisfaction; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones