Atlantoaxial Osteoarthritis: An Overlooked Condition

Area of Science:

• Orthopedics
• Rheumatology
• Radiology

Background:

• Atlantoaxial osteoarthritis (AAOA) presents as occipitocervical pain and restricted cervical rotation.
• Clinical recognition is frequently inadequate, leading to misdiagnosis and suboptimal management.
• Incidence increases with age, affecting up to 18% of individuals in their ninth decade.

Purpose of the Study:

• To synthesize current data on AAOA.
• To enhance understanding of AAOA's diagnosis and management within the orthopedic community.

Main Methods:

• Review of existing literature on atlantoaxial osteoarthritis.
• Analysis of diagnostic imaging techniques, including open mouth odontoid views, MRI, and CT scans.
• Evaluation of conservative and surgical treatment strategies.

Main Results:

• Risk factors include advanced age, female sex, and occupational cervical strain.
• Pain stems from C1-C2 joint degeneration, potentially referred via the greater occipital nerve.
• Conservative treatments (physiotherapy, medication, injections) yield improvement in up to two-thirds of patients.

Conclusions:

• The open mouth odontoid view is crucial for diagnosing AAOA, though MRI and CT scans aid confirmation.
• Initial management should be conservative, with surgery reserved for intractable pain.
• Surgical success hinges on anatomical knowledge and advanced C1-C2 fusion techniques.