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Ferch RD, Zhang T, Bogduk N. Athrodesis of the lateral atlanto-axial joint for the relief of neck pain and cervicogenic headache. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:203-210. [PMID: 37982760 PMCID: PMC10906710 DOI: 10.1093/pm/pnad153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/07/2023] [Accepted: 11/09/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Osteoarthrosis of the lateral atlanto-axial joint (LAAJ) may be a cause of upper neck pain and headache. Intra-articular injection of steroids may provide only short-lasting relief. For intractable pain, arthrodesis of the joint might be considered. OBJECTIVE To determine the success rates of arthrodesis of the lateral atlanto-axial joint for relieving neck pain and disability. DESIGN Practice audit. SETTING Private practice of senior author. SUBJECTS Prospective series of 23 consecutive patients. METHODS Outcomes were measured using a numerical rating scale for neck pain, and the Neck Disability Index for disability. Success rates were calculated for various degrees of improvement of neck pain at long-term follow-up (8-40 months), and for achieving various combinations of improvement of both neck pain and disability. RESULTS Complete relief of pain was achieved in 40% of patients, with a further 40% achieving at least 50% relief. At long-term follow-up, 30% of patients had no neck pain and no disability, and a further 25% had only minimal pain, minimal disability, or both. CONCLUSIONS The present study did not corroborate earlier studies that claimed outstanding outcomes for arthrodesis of the LAAJ, but its outcomes are consonant with more recent studies that provided transparent outcome data. These studies provide Pain Physicians with empirical data on success rates and outcomes, upon which they can base their consideration of referral for arthrodesis.
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Affiliation(s)
- Richard D Ferch
- Department of Neurosurgery, John Hunter Hospital, Newcastle, NSW 2305, Australia
| | - Tyson Zhang
- Department of Neurosurgery, John Hunter Hospital, Newcastle, NSW 2305, Australia
| | - Nikolai Bogduk
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia
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Yin M, Ding X, Liu S, Ma J, Mo W. Research Progress of Atlantoaxial Osteoarthritis: A Narrative Literature Review. World Neurosurg 2022; 160:e573-e578. [PMID: 35092813 DOI: 10.1016/j.wneu.2022.01.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/19/2022] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The purpose of this review was to consolidate the current literature related to atlantoaxial osteoarthritis (AAOA) and improve the systematic understanding of this clinical syndrome among spine surgeons. METHODS Articles reviewed were searched in PubMed, Ovid MEDLINE, and EMBASE using search terms: [("C1-C2" OR "C1-2" OR "atlantoaxial" OR "atlanto-axial" OR "C2" OR "C1" OR "atlas" OR "axis") AND ("osteoarthritis")]. All articles of any study design discussing on AAOA were considered for inclusion. Two independent authors read article titles, abstracts and the included appropriate articles. The relevant articles were studied in full text. RESULTS A total of 54 literatures were reviewed and consolidated in this narrative review. These articles are roughly divided into the following five subcategories: (1) epidemiology and etiology, (2) clinical presentation, (3) radiographic findings, (4) conservative treatment and (5) surgical indications and treatment options. CONCLUSION AAOA was a clinically common but often overlooked syndrome characterized by persistent occipitocervical pain. The most common cause of AAOA was joint degeneration, which was closely related to age and occupation. Initial treatment for AAOA was conservative. Atlantoaxial fusion was an option for patients with severe pain who unresponsive to conservative management.
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Affiliation(s)
- Mengchen Yin
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xing Ding
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shuang Liu
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Junming Ma
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wen Mo
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Fujimoto M, Nishikawa H, Tanioka S, Ikezawa M, Suzuki Y, Kuroda Y, Mizuno M, Suzuki H. Dynamic magnetic resonance imaging to demonstrate C2 radiculopathy secondary to atlantoaxial osteoarthritis causing occipital neuralgia: A case report. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Abstract
Lateral atlantoaxial osteoarthritis (AAOA), or C1-C2 lateral mass arthritis (LMA), is an unfamiliar degenerative cervical disease with a clinical presentation that markedly differs from subaxial spondylosis. The prevalence of LMA in the nonsurgical outpatient setting is 4%. Risk factors include age and occupation. The typical patient is between 50 and 90 years old, presents with upper cervical or occipital pain, has limited rotation, and has pain provocation during passive rotation to the affected side. Pain stems from degeneration of the lateral C1-C2 articulation and may be referred or radicular, through the greater occipital nerve. Although there is no consensus on diagnostic work-up, the disease is classically seen on the open-mouth odontoid radiograph. Computerized tomography, magnetic resonance imaging, bone scan, and diagnostic injections are also useful. Initial treatment is conservative, and upwards of two-thirds of LMA patients obtain lasting relief with noninvasive measures and injections. In patients with severe, recalcitrant pain, limited C1-C2 fusion offers satisfactory and reliable relief. The goals of this review article are to provide a synthesis of the literature on LMA, to offer a treatment approach to LMA, and to identify problems with the current state of knowledge on LMA.
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Russo VM, Duits A, Dhawan RT, Casey ATH. Joint arthropathy at the cranio-vertebral junction. Scintigraphic patterns on bone SPECT/CT. Br J Neurosurg 2016; 31:45-49. [PMID: 27848263 DOI: 10.1080/02688697.2016.1226254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Osteoarthritic degeneration at the cranio-vertebral junction (CVJ) is an underrecognized source of suboccipital and neck pain, limited range of motion and cervicogenic headaches. Correlation of radiographic findings with clinical symptoms is often difficult. Limited evidence currently exists to support the use of bone single-photon emission computed tomography/computed tomography (SPECT/CT) in this subgroup of patients. The aim of this study was to describe the scintigraphic patterns of joint arthropathy at the CVJ on bone SPECT/CT in patients with suboccipital/neck pain and cervicogenic headache. Patients with more than 3 months of suboccipital/neck pain/cervicogenic headache and abnormal SPECT/CT findings at the CVJ were included. Patients with known/suspected malignancy, trauma, infectious processes and previous surgery at the CVJ were excluded. Neck disability index (NDI), visual analogue scale (VAS) and treatment were recorded for each patient. Patterns of osteoblastic activity at the CVJ on bone SPECT/CT were described and correlated with arthritic changes on conventional scans. Eighteen patients were included (10 females, mean age 68). Mean NDI score was 22. Mean VAS was 7.5. On bone SPECT/CT, it was found that 13 patients had high osteoblastic activity unilaterally at the atlanto-axial joint (AAJ); two patients at the atlanto-dental joint (ADJ), one at the occipito-atlantal joint (OAJ), one at both OAJ and ADJ and one at the level of C2 pars/pedicle unilaterally. Metabolic activity on SPECT/CT was associated with severe degenerative changes on CT scans. The ability of hybrid bone SPECT/CT to precisely localize osteoblastic activity at the CVJ may provide significant improvement in the diagnosis and treatment of patients with suboccipital/neck pain and joint arthropathy at the CVJ. Further clinical studies are needed to establish the real clinical impact of bone SPECT/CT in the treatment of patients with suboccipital neck pain.
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Affiliation(s)
- Vittorio M Russo
- a Department of Neurosurgery , The National Hospital for Neurology and Neurosurgery , London , UK
| | - Anneli Duits
- a Department of Neurosurgery , The National Hospital for Neurology and Neurosurgery , London , UK
| | - Ranju T Dhawan
- b Department of Hybrid Functional Imaging & Nuclear Medicine , The Wellington Hospital , London , UK
| | - Adrian T H Casey
- a Department of Neurosurgery , The National Hospital for Neurology and Neurosurgery , London , UK
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Fujiwara Y, Izumi B, Fujiwara M, Nakanishi K, Tanaka N, Adachi N, Manabe H. C2 spondylotic radiculopathy: the nerve root impingement mechanism investigated by para-sagittal CT/MRI, dynamic rotational CT, intraoperative microscopic findings, and treated by microscopic posterior foraminotomy. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:1073-1081. [PMID: 27443532 DOI: 10.1007/s00586-016-4710-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 06/22/2016] [Accepted: 07/15/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE C2 radiculopathy is known to cause occipito-cervical pain, but their pathology is unclear because of its rarity and unique anatomy. In this paper, we investigated the mechanism of C2 radiculopathy that underwent microscopic cervical foraminotomies (MCF). METHODS Three cases with C2 radiculopathy treated by MCF were investigated retrospectively. The mean follow-up period was 24 months. Pre-operative symptoms, imaging studies including para-sagittal CT and MRI, rotational dynamic CT, and intraoperative findings were investigated. RESULTS There were 1 male and 2 females. The age of patients were ranged from 50 to 79 years. All cases had intractable occipito-cervical pain elicited by the cervical rotation. C2 nerve root block was temporally effective. There was unilateral spondylosis in symptomatic side without obvious atlatoaxial instability. Para-sagittal MRI and CT showed severe foraminal stenosis at C1-C2 due to the bony spur derived from the lateral atlanto-axial joints. In one case, dynamic rotational CT showed that the symptomatic foramen became narrower on rotational position. MCF was performed in all cases, and the C2 nerve root was impinged between the inferior edge of the C1 posterior arch and bony spur from the C1-C2 joint. After surgery, occipito-cervical pain disappeared. CONCLUSION This study demonstrated that mechanical impingement of the C2 nerve root is one of the causes of occipito-cervical pain and it was successfully treated by microscopic resection of the inferior edge of the C1 posterior arch. Para-sagittal CT and MRI, rotational dynamic CT, and nerve root block were effective for diagnosis.
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Affiliation(s)
- Yasushi Fujiwara
- Department of Orthopedic Surgery, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabe-minami, Asa-kita-ku, Hiroshima, 731-0293, Japan.
| | - Bunichiro Izumi
- Department of Orthopedic Surgery, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabe-minami, Asa-kita-ku, Hiroshima, 731-0293, Japan
| | - Masami Fujiwara
- Department of Orthopedic Surgery, Sada Hospital, Fukuoka, Japan
| | - Kazuyoshi Nakanishi
- Department of Orthopaedic Surgery, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuhiro Tanaka
- Department of Orthopaedic Surgery, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hideki Manabe
- Department of Orthopedic Surgery, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabe-minami, Asa-kita-ku, Hiroshima, 731-0293, Japan
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Pakzaban P. Mechanism of Efficacy of Microvascular Decompression for Trigeminal Neuralgia. World Neurosurg 2016; 85:3. [PMID: 26776743 DOI: 10.1016/j.wneu.2015.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 09/01/2015] [Indexed: 02/05/2023]
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Guha D, Mohanty C, Tator CH, Shamji MF. Occipital neuralgia secondary to unilateral atlantoaxial osteoarthritis: Case report and review of the literature. Surg Neurol Int 2016; 6:186. [PMID: 26759731 PMCID: PMC4697204 DOI: 10.4103/2152-7806.172531] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 10/10/2015] [Indexed: 11/20/2022] Open
Abstract
Background: Atlantoaxial osteoarthritis (AAOA), either in isolation or in the context of generalized peripheral or spinal arthritis, presents most commonly with neck pain and limitation of cervical rotational range of motion. Occipital neuralgia (ON) is only rarely attributed to AAOA, as fewer than 30 cases are described in the literature. Case Description: A 64-year-old female presented with progressive incapacitating cervicalgia and occipital headaches, refractory to medications, and local anesthetic blocks. Computed tomography and magnetic resonance imaging studies documented advanced unilateral atlantoaxial arthrosis with osteophytic compression that dorsally displaced the associated C2 nerve root. Surgical decompression and atlantoaxial fusion achieved rapid and complete relief of neuralgia. Ultimately, postoperative spinal imaging revealed osseous union. Conclusions: Atlantoaxial arthrosis must be considered in the differential diagnosis of ON. Surgical treatment is effective for managing refractory cases. Intraoperative neuronavigation is also a useful adjunct to guide instrumentation and the intraoperative extent of bony decompression.
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Affiliation(s)
- Daipayan Guha
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Chandan Mohanty
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Charles H Tator
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mohammed F Shamji
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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Kucinski T, Schubert J. FOAR: Facet Joint Osteoarthritis with Radiculopathy: a case series and a hypothesis explaining spinal nerve irritation in the absence of osteodiskal compression. Clin Neuroradiol 2014; 25:83-7. [PMID: 24522453 DOI: 10.1007/s00062-013-0275-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 12/02/2013] [Indexed: 11/24/2022]
Affiliation(s)
- T Kucinski
- Radiologie am Rathausmarkt,, Radiologische Allianz Hamburg, Mönckebergstrasse 31, 20095, Hamburg, Germany,
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Elliott RE, Tanweer O, Smith ML, Frempong-Boadu A. Outcomes of fusion for lateral atlantoaxial osteoarthritis: meta-analysis and review of literature. World Neurosurg 2012; 80:e337-46. [PMID: 23022635 DOI: 10.1016/j.wneu.2012.08.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2012] [Revised: 07/21/2012] [Accepted: 08/20/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Atlantoaxial osteoarthritis (AAOA) is an underrecognized source of neck pain, limitation of range of motion, and cervicogenic headaches. When conservative treatments such as facet injections fail, fusion may be indicated. We reviewed published series describing posterior fusions for atlantoaxial osteoarthritis of the facet joints. METHODS Online databases were searched for English-language articles describing the diagnosis and treatment of AAOA. Twenty-three studies reporting on 246 patients treated with posterior fusion for lateral AAOA fulfilled inclusion criteria. Standard statistical and formal meta-analytic techniques were used to assess outcomes. RESULTS All studies provided class III evidence. The 30-day perioperative mortality was 1.2% and neurologic injury did not occur. Patients were followed for a mean of nearly 5 years. Fusion was successful in 98% of patients with a single operation and with 99.5% of patients after revision surgery. Intractable preoperative neck pain either resolved completely or improved in 97.7% of patients. Using meta-analytic techniques, the point estimate for improvement or resolution of pain was 92.6% (confidence interval = 86.8%-96.0%) and the rate of arthrodesis for AAOA was 92.2% (confidence interval = 85.6%-95.9%) and there were no differences among the various techniques used for fusion. Operative complications were few. CONCLUSIONS Posterior C1-2 fusion is a safe and effective treatment option for patients with intractable neck pain secondary to lateral AAOA. Modern fusion options offer a high rate of arthrodesis and low risk of morbidity if conservative therapies fail to provide adequate pain relief.
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Affiliation(s)
- Robert E Elliott
- Neurosurgical Care, LLC., Royersford, Pennsylvania, New York, New York, USA.
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