OSTEOARTHROSIS OF THE ATLANTOAXIAL JOINTS - LONG-TERM FOLLOW-UP AFTERTREATMENT WITH ARTHRODESIS

We evaluated the results for fifteen patients in whom symptomatic oste oarthrosis of the atlanto-axial joints had been treated with an atlant o-axial or occipitocervical arthrodesis between 1973 and 1990, Thirtee n patients had long-term follow-up (average duration, seven years and two months; range, four years and two months to nineteen years and two months), The two remaining patients had died: one, four days postoper atively, from a cardiopulmonary arrest, and the other, one year and ei ght months postoperatively; from complications related to bladder canc er, Preoperatively, all fifteen patients reported pain in the occipito cervical region that increased with any attempt at rotation of the nec k and was unresponsive to immobilization with a collar and to analgesi cs, The average duration of the symptoms before the arthrodesis was th ree years, One patient had acute quadriparesis. All patients had radio graphic evidence of osteoarthrosis involving the lateral atlanto-axial articulations. Four patients had atlanto-axial instability with an av erage of five millimeters (range, three to ten millimeters) of motion at the anterior atlanto-odontoid interval, Six patients had an associa ted spontaneous subaxial fusion, which was secondary to osteoarthrosis in five; three of the five also had atlanto-axial instability Fourtee n patients were managed with a posterior arthrodesis and one, with an anterior transoral arthrodesis. The procedures were performed to relie ve pain, to stabilize the atlanto-axial joints, and to restore neurolo gical function. Of the fourteen patients who were followed, thirteen h ad a solicit fusion and one had a stable pseudarthrosis, The patient w ho had quadriparesis recovered, At the latest follow-up evaluation, th irteen patients had an excellent result and one had a fair result as d etermined with use of a modification of the criteria of Robinson et al , There were no poor results. Atlanto-axial arthrodesis can effectivel y relieve occipitocervical pain and correct atlanto-axial instability secondary to osteoarthrosis.