Skip to main content

Advertisement

SpringerLink
Log in

Myelopathy resulting from degenerative atlantoaxial subluxation

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

To present the clinical features and treatment strategy of degenerative atlantoaxial subluxation (DAAS).

Methods

Patients with DAAS treated in our institution from 2003 to 2020 were retrospectively reviewed. We utilized the Japanese Orthopedic Association (JOA) scale to evaluate the neurologic status and distance of Ranawat et al. (DOR) to measure vertical migration.

Results

We recruited 40 patients with > 2 years of follow-up and an average age of 62.3 ± 7.7 years. All the patients had myelopathy; only one patient had moderate trauma before exacerbation of symptoms, and the duration of symptoms was 34 ± 36 months. The most frequent radiological features were vertical migration of C1 (100%), sclerosis (100%), and narrowing of the atlantoaxial lateral mass articulations (100%). Two patients underwent transoral release combined with posterior reduction and fusion, and 38 patients underwent posterior reduction and fusion with C1 lateral mass screws-C2 pedicle screws and plate systems only. Forty cases (100%) achieved a solid atlantoaxial fusion, and 38 cases (95%) achieved anatomic atlantoaxial reduction. The JOA score increased from 9.3 ± 2.6 to 14.8 ± 2.1 (P < 0.01). DOR increased from 14.5 ± 2.5 to 17.8 ± 2.2 mm at the final follow-up (P < 0.01). Loosening of the locking caps was detected in one case, bony fusion was achieved, and harvest-site pain was reported in five patients.

Conclusion

DAAS differs from other types of AAS and presents with anterior subluxation combined with vertical subluxation arising from degenerative changes in the atlantoaxial joints. We recommend anatomic reduction as an optimal strategy for DAAS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Casey AT, Crockard HA, Geddes JF et al (1997) Vertical translocation: the enigma of the disappearing atlantodens interval in patients with myelopathy and rheumatoid arthritis. Part I. Clinical, radiological, and neuropathological features. J Neurosurg 87:856–862. https://doi.org/10.3171/jns.1997.87.6.0856

    Article  CAS  PubMed  Google Scholar 

  2. Sato K, Senma S, Abe E et al (1996) Myelopathy resulting from the atlantodental hypertrophic osteoarthritis accompanying the dens hypertrophy Two case reports. Spine (Phila Pa 1976) 21:1467–1471. https://doi.org/10.1097/00007632-199606150-00013

    Article  CAS  PubMed  Google Scholar 

  3. Goel A, Shah A, Gupta SR (2010) Craniovertebral instability due to degenerative osteoarthritis of the atlantoaxial joints: analysis of the management of 108 cases. J Neurosurg Spine 12:592–601. https://doi.org/10.3171/2009.12.SPINE0999

    Article  PubMed  Google Scholar 

  4. Laheri V, Chaudhary K, Rathod A et al (2015) Anterior transoral atlantoaxial release and posterior instrumented fusion for irreducible congenital basilar invagination. Eur Spine J 24:2977–2985. https://doi.org/10.1007/s00586-015-3836-y

    Article  PubMed  Google Scholar 

  5. Samartzis D, Modi HN, Cheung KM et al (2013) A new mechanism of injury in ankylosing spondylitis: non-traumatic hyperextension causing atlantoaxial subluxation. Bone Joint J 95:206–209. https://doi.org/10.1302/0301-620X.95B2.29554

    Article  PubMed  Google Scholar 

  6. Wang S, Wang C (2015) Atlantoaxial dislocations. In: Peter G (ed) Cervical myelopathy. Jaypeebrothers, New York, pp 117–118

    Google Scholar 

  7. Daumen-Legre V, Lafforgue P, Champsaur P et al (1999) Anteroposterior atlantoaxial subluxation in cervical spine osteoarthritis: case reports and review of the literature. J Rheumatol 26:687–691

    CAS  PubMed  Google Scholar 

  8. Fung M, Frydenberg E, Barnsley L et al (2018) Clinical and radiological outcomes of image guided posterior C1–C2 fixation for atlantoaxial osteoarthritis (AAOA). J Spine Surg. 4:725–735. https://doi.org/10.21037/jss.2018.12.04

    Article  PubMed  PubMed Central  Google Scholar 

  9. Harata S, Tohno S, Kawagishi T (1981) Osteoarthritis of the atlanto-axial joint. Int Orthop 5:277–282. https://doi.org/10.1007/BF00271083

    Article  CAS  PubMed  Google Scholar 

  10. Finn M, Fassett DR, Apfeibaum RI (2007) Surgical treatment of nonrheumatoid atlantoaxial degenerative arthritis producing pain and myelopathy. Spine (Phila Pa 1976) 32:3067–3073. https://doi.org/10.1097/BRS.0b013e31815d004c

    Article  PubMed  Google Scholar 

  11. Halla JT, Hardin JG Jr (1987) Atlantoaxial (C1–C2) facet joint osteoarthritis: a distinctive clinical syndrome. Arthritis Rheum 30:577–582. https://doi.org/10.1002/art.17180300514

    Article  CAS  PubMed  Google Scholar 

  12. Ghanayem AJ, Leventhal M, Bohlman HH (1996) Osteoarthrosis of the atlanto-axial joints. Long-term follow-up after treatment with arthrodesis. J Bone Joint Surg Am 78:1300–1307. https://doi.org/10.2106/00004623-199609000-00002

    Article  CAS  PubMed  Google Scholar 

  13. Ranawat CS, O’Leary P, Pellicci P et al (1979) Cervical spine fusion in rheumatoid arthritis. J Bone Joint Surg Am 61:1003–1010

    Article  CAS  PubMed  Google Scholar 

  14. Wang C, Yan M, Zhou HT et al (2006) Open reduction of irreducible atlantoaxial dislocation by transoral anterior atlantoaxial release and posterior internal fixation. Spine (Phila Pa 1976) 31:E306–E313. https://doi.org/10.1097/01.brs.0000217686.80327.e4

    Article  PubMed  Google Scholar 

  15. Whitesides TE Jr, McDonald AP (1978) Degenerative arthritis of the occipito-cervical region-signs and symptoms. Orthop Trans 2:32

    Google Scholar 

  16. Berlemann U, Läubli R, Moore RJ (2002) Degeneration of the atlanto-axial joints: a histological study of 9 cases. Acta Orthop Scand 73:130–133. https://doi.org/10.1080/000164702753671687

    Article  PubMed  Google Scholar 

  17. Badve SA, Bhojraj S, Nene A et al (2010) Occipito-atlanto-axial osteoarthritis: a cross sectional clinico-radiological prevalence study in high risk and general population. Spine (Phila Pa 1976) 35:434–438. https://doi.org/10.1097/BRS.0b013e3181b13320

    Article  PubMed  Google Scholar 

  18. Betsch MW, Blizzard SR, Shinseke MS et al (2015) Prevalence of degenerative changes of the atlanto-axial joints. Spine J 15:275–280. https://doi.org/10.1016/j.spinee.2014.09.011

    Article  PubMed  Google Scholar 

  19. Liu K, Lu Y, Cheng D et al (2014) The prevalence of osteoarthritis of the atlanto-odontoid joint in adults using multidetector computed tomography. Acta Radiol 55:95–100. https://doi.org/10.1177/0284185113492722

    Article  PubMed  Google Scholar 

  20. Goel A, Shah A, Rajan S (2009) Vertical mobile and reducible atlantoaxial dislocation Clinical article. J Neurosurg Spine 11:9–14. https://doi.org/10.3171/2009.3.SPINE08927

    Article  PubMed  Google Scholar 

  21. Dokai T, Nagashima H, Okano T et al (2013) Morphological and volumetric analysis of the development of atlantoaxial vertical subluxation in rheumatoid arthritis. Yonago Acta Med 56:21–27

    CAS  PubMed  PubMed Central  Google Scholar 

  22. Shimada H, Abematsu M, Ishido Y et al (2011) Classification of odontoid destruction in patients with rheumatoid arthritis using reconstructed computed tomography: reference to vertical migration. J Rheumatol 38:863–867. https://doi.org/10.3899/jrheum.100942

    Article  PubMed  Google Scholar 

  23. Yamada T, Yoshii T, Matsukura Y et al (2019) Retrospective analysis of surgical outcomes for atlantoaxial subluxation. J Orthop Surg Res 14:75. https://doi.org/10.1186/s13018-019-1112-2

    Article  PubMed  PubMed Central  Google Scholar 

  24. Yoshida G, Kamiya M, Yukawa Y et al (2012) Rheumatoid vertical and subaxial subluxation can be prevented by atlantoaxial posterior screw fixation. Eur Spine J 21:2498–2505. https://doi.org/10.1007/s00586-012-2444-3

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This study was funded by the Beijing Natural Science Foundation (NO.7232204). The authors would like to thank Mr. Xiang Shi for his help in drawing illustration in this study.

Author information

Authors and Affiliations

  1. Department of Orthopedics, Peking University Third Hospital, NO. 49 North Garden Road, Haidian District, Beijing, China

    Yongqiang Wang & Chao Wang

  2. Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China

    Yongqiang Wang & Chao Wang

  3. Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China

    Chao Wang & Ming Yan

Authors
  1. Yongqiang Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chao Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ming Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chao Wang.

Ethics declarations

Conflict of interest

No conflict of interest exist in this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 35 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, Y., Wang, C. & Yan, M. Myelopathy resulting from degenerative atlantoaxial subluxation. Eur Spine J 33, 176–184 (2024). https://doi.org/10.1007/s00586-023-07860-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-023-07860-9

Keywords

Search

Navigation