Psoriatic arthritis with C-1-C-2 subluxation as a neurosurgical complication

A 39-year-old man presented with a 10-year history of psoriatic arthritis, and more recently a progressive high cervical myelopathy. The development of the myelopathy syndrome was unassociated with trauma or any other specific inciting cause. Cervical spine x-rays demonstrated a significant atlantoaxial subluxation. Other x-ray features of the spine met the criteria for diagnosis of psoriatic spondylitis. The association of a high cervical myelopathy with atlantoaxial subluxation in psoriatic spondylitis is rare. Conversely, atlantoaxial subluxation without high cervical myelopathy has been reported in 45% of cases of psoriatic spondylitis. The authors report this case with a review of the diagnosis, possible pathogenesis, and treatment of atlantoaxial subluxation in psoriatic spondylitis.