Atlantoaxial osteoarthritis: case series analysis and literature review

Objective. To present rare clinical cases of atlantoaxial osteoarthritis (AAOA), review modern surgical methods and describe our experience in surgical treatment of this pathology. Material and methods. The study included five patients who underwent surgery for AAOA. All patients presented with persistent drug-resistant pain. Unilateral degenerative damage to the paired atlantoaxial joint was present in four patients, bilateral damage — in 1 case. Posterior atlantoaxial fusion (Gallie technique) was performed in one case. Screw C1—C2 fixation (Harms technique) and arthrodesis of damaged atlantoaxial joint were carried out in four cases. Results. All patients decreased VAS score of pain by 6—7 points (mean 6.6) after surgery. A follow-up examination confirmed successful fusion in each case. All patients experienced significant limitation of head rotation due to atlantoaxial articulation blockage associated with concomitant spondyloarthrosis. Conclusion. Drug-resistant pain and/or cervical myelopathy are indications for surgical treatment of AAOA. Posterior fusion is the only effective method for pain relief. Relief of clinical symptoms minimizes lost head rotation. Harms fusion technique enables complete consolidation thanks to stable fusion. Atlantoaxial arthrodesis enhances C1—C2 vertebral block.