Craniovertebral instability due to degenerative osteoarthritis of the atlantoaxial joints: analysis of the management of 108 cases.
OBJECTIVE
The authors retrospectively analyzed a series of 108 patients in whom was diagnosed atlantoaxial instability due to degenerative osteoarthritis of the atlantoaxial joints. The management issues in such cases are discussed.


METHODS
One hundred eight patients with osteoarthritis of the atlantoaxial joints and resultant craniovertebral instability-diagnosed on the basis of presenting clinical features, radiological imaging, and direct observation of the joint status during surgery-were retrospectively analyzed. Between 1990 and 2008, these patients were treated with a C1-2 lateral mass plate and screw method of atlantoaxial fixation and joint distraction using bone graft with or without the assistance of metal spacers.


RESULTS
Patient ages ranged from 48 to 84 years (average 63 years). There was a history of mild to moderate head and/or neck trauma 2 months to 11 years prior to diagnosis in 40% of the cases. All patients had symptoms of neck pain, and 82% of the patients had progressive myelopathy. A reduction in the height of the atlantoaxial lateral mass complex (100%), mobile atlantoaxial dislocation (100%), basilar invagination (68%), and periodontoid degenerative tissue mass (90%) were the more frequently encountered radiological features. Two patients died in the immediate postoperative period. At an average follow-up of 64 months, all surviving patients remarkably improved to varying degrees in their neurological condition.


CONCLUSIONS
Atlantoaxial joint arthritis frequently leads to craniovertebral instability and cord compression. Treatment by joint distraction and lateral mass fixation can be an optimum form of treatment.
Department of Neurosurgery, King Edward VII Memorial Hospital and Seth G. S. Medical College, Parel, Mumbai, India. atulgoel62@hotmail.com
Atul
A
Goel
Abhidha
A
Shah
Sanjay Rajan
SR
Gupta
D000368:Aged; D000369:Aged, 80 and over; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications* / Q000601:surgery; D011183:Postoperative Complications; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome