3 years ago

Ankylosing Spondylitis Manifested by Extensive Cervical Erosions with Spontaneous Anterior Atlantoaxial Subluxation

Jia Liu, Lingjun Zhu, Enze Jiang, Sili Zou, Guohua Xu

Publication date: Available online 4 November 2018

Source: World Neurosurgery

Author(s): Jia Liu, Lingjun Zhu, Enze Jiang, Sili Zou, Guohua Xu

Abstract
Purpose

We present a rare case of atlantoaxial instability as a result of bone erosions in a patient with ankylosing spondylitis and review the literature. We describe the radiographic characters, pathology and treatment of the case, hoping to shed light on the rare clinical manifestation.

Methods

We present a case of a 36-year-old male with an 8-year history of ankylosing spondylitis with a progressive neck pain, low back pain, hand numbness and motion limitation of neck. Cervical radiography showed anterior atlantoaxial subluxation with bone erosions at the odontoid process, mass lateral of atlas and edge of vertebrae. The patient was diagnosed as ankylosing spondylitis according to the modified New York criteria and underwent a posterior C0 to C6 occipitocervical arthrodesis surgery and C3 to C6 laminectomy to reconstruct atlantoaxial stability and relieve cervical compression.

Results

The symptoms of neck pain and hand numbness improved at the 1-year follow-up, and the patient completely resumed normal activities. Imaging examinations showed the realignment of C1-2 with complete decompression of spinal cord and fusion of atlantooccipital joint. The internal fixation has remained stable and progressive bone erosions changes were not found after the surgery.

Conclusions

Extensive cervical erosions with spontaneous atlantoaxial subluxation in ankylosing spondylitis is extremely rare. The erosive change of atlantoaxial bone may be an early feature of ankylosing spondylitis. Cervical spine radiographic examination are essential for ankylosing spondylitis patients with neck pain. Complete decompression and internal fixation are necessary to prevent serious neurological morbidity from spinal cord injury for such patients.

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