title: Occipital neuralgia secondary to unilateral atlantoaxial osteoarthritis: Case report and review of the literature.
abstract: BACKGROUND
  Atlantoaxial osteoarthritis (AAOA), either in isolation or in the context of generalized peripheral or spinal arthritis, presents most commonly with neck pain and limitation of cervical rotational range of motion. Occipital neuralgia (ON) is only rarely attributed to AAOA, as fewer than 30 cases are described in the literature.
  
  
  METHODS
  A 64-year-old female presented with progressive incapacitating cervicalgia and occipital headaches, refractory to medications, and local anesthetic blocks. Computed tomography and magnetic resonance imaging studies documented advanced unilateral atlantoaxial arthrosis with osteophytic compression that dorsally displaced the associated C2 nerve root. Surgical decompression and atlantoaxial fusion achieved rapid and complete relief of neuralgia. Ultimately, postoperative spinal imaging revealed osseous union.
  
  
  CONCLUSIONS
  Atlantoaxial arthrosis must be considered in the differential diagnosis of ON. Surgical treatment is effective for managing refractory cases. Intraoperative neuronavigation is also a useful adjunct to guide instrumentation and the intraoperative extent of bony decompression.
authors.affiliation: Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Daipayan
authors.initials: D
authors.lastname: Guha
authors.affiliation: Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Chandan
authors.initials: C
authors.lastname: Mohanty
authors.affiliation: Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Charles H
authors.initials: CH
authors.lastname: Tator
authors.affiliation: Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Mohammed F
authors.initials: MF
authors.lastname: Shamji
keywords: Atlantoaxial fusion; occipital neuralgia; osteoarthritis