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Inflammatory bowel disease and the craniocervical junction.

Timothy Ryken, Arnold Menezes

Neurosurgical Focus

|September 16, 2006

Summary

Inflammatory bowel disease can cause serious spinal issues, including rare but severe craniocervical instability. Prompt diagnosis and surgical intervention are crucial for recovery from related neurological deficits.

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Area of Science:

Medicine
Rheumatology
Neurosurgery

Background:

Rheumatological complications affect up to 30% of inflammatory bowel disease (IBD) patients.
Most IBD-associated rheumatological issues involve lumbar spondylitis.
Less common erosive arthritis can lead to ligamentous laxity and joint instability.

Purpose of the Study:

To highlight the significance of craniocervical junction involvement in IBD.
To present a case of severe craniocervical instability secondary to ulcerative colitis.

Main Methods:

Case report of a 56-year-old female with ulcerative colitis.
Initial C1-3 fusion for atlantoaxial instability.
Subsequent traction reduction and combined anterior transoral decompressive-posterior occipitocervical fusion for unrecognized occipitoatlantal instability.

Main Results:

The patient developed high cervicomedullary quadriplegia due to unrecognized occipitoatlantal instability.
Surgical intervention successfully reduced the instability and decompressed the neural structures.
Complete resolution of the neurological deficit was achieved postoperatively.

Conclusions:

Craniocervical instability is a rare but potentially devastating complication of IBD.
Early recognition and comprehensive surgical management are vital for favorable outcomes.
This case underscores the importance of evaluating the entire cervical spine in IBD patients with suspected instability.

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