Rheumatoid atlantoaxial instability treated by anterior transarticular C1-C2 fixation. Case report

The authors present a case that demonstrates the usefulness of anterior transarticular screw fixation in the treatment of instability due to rheumatoid arthritis. The surgical technique of this infrequently used procedure is presented. A 35-year-old female patient with medical history significant for rheumatoid arthritis complained of persistent headache and upper neck pain. Examination revealed a decreased range of cervical rotational motion. Magnetic resonance imaging of the cervical spine revealed anterior displacement of C1, destruction of the left lateral atlantoaxial articulation and bony erosion of the C2 vertebral body below the base of the odontoid. Dynamic radiographs showed increased C1-C2 mobility. The authors used a right anterolateral approach to the cervical spine to perform fixation of lateral atlantoaxial articulations by means of titanium cannulated compressive screws. On 4-month follow-up examination, successful C1-C2 stabilization was documented. Despite restriction of neck rotation, the patient reported satisfactory improvement and re-turned to work.