Atlantoaxial osteoarthritis: case series and review of the literature

The intention of this study is to present our experience in the surgical treatment of painful atlantoaxial osteoarthritis (AAOA) and review the literature on this subject. Osteoarthritis of the atlantoaxial joints is more common than is generally suspected. It has a prevalence between 5 and 18%. Only a minority of patients becomes symptomatic suffering from severe suboccipital pain, irradiating into the occiput, vertex and sometimes as far as the eyes. Most often, these patients can successfully be treated conservatively. Some of these patients however require operative treatment. The study includes five patients with painful AAOA (one posttraumatic, four idiopathic) not responding to conservative treatment for a minimum of six months. Rheumatoid arthritis was excluded. All but one patient were female and all but one patient were over 50 years old (mean 64 years). The origin of pain was confirmed by diagnostic C1–C2 facet blocks in all patients. The patients were treated with a C1–C2 transarticular screw fixation and Gallie type fusion. Patients were followed clinically and radiologically for a minimum of 24 months. Mean follow-up was 38 months (24–48). In all patients the typical pain disappeared immediately after surgery and has not reoccurred. Pain intensity on the VAS decreased from 100 to 34. At the latest follow-up radiologically solid fusion and stable implants were found in all cases. All five patients would undergo this surgery for the same condition again. C1–C2 fusion effectively relieves occipitocervical pain in AAOA non responsive to conservative treatment.