Surgical treatment for atlantooccipital osteoarthritis: a case report of two patients.
OBJECTIVE
Although rarely discussed in the literature and difficult to evaluate on plain radiographs, atlantooccipital osteoarthritis can be a source of persistent suboccipital pain. Our objective in this report is to describe two cases with atlantooccipital (O-C1) osteoarthritis treated with posterior occipitocervical fusion.


RESULTS
Two patients presented with unilateral suboccipital pain, which was refractory to conservative treatment. One patient suffered from long-standing rheumatoid arthritis while the other patient did not have pertinent medical issues. After non-diagnostic plain film imaging, CT scan demonstrated unilateral osteoarthritis of the atlantooccipital and atlantoaxial joint in both patients who subsequently underwent posterior O-C2 fusion with resolution of their preoperative symptoms.


CONCLUSIONS
This is, to our knowledge, the first case report which specifically focused on surgical treatment of atlantooccipital osteoarthritis. Occipitocervical fusion is a treatment option for patients with atlantooccipital osteoarthritis when suboccipital pain is not responsive to conservative treatment.
Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. hiroyoshihara55@yahoo.co.jp
Hiroyuki
H
Yoshihara
Christopher
C
Kepler
Kazuhiro
K
Hasegawa
Bernard A
BA
Rawlins
D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D001269:Atlanto-Occipital Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D001863:Bone Screws; D005260:Female; D006801:Humans; D055013:Osteoarthritis, Spine / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D010146:Pain / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D011859:Radiography; D013123:Spinal Fusion; D016896:Treatment Outcome