Osteoarthritis--a rare indication for atlantoaxial fusion. A case report and review of the literature.

The authors report a case of C1-C2 fusion which was performed in a 64-year-old woman with unilateral atlantoaxial osteoarthritis, who consulted because of incapacitating occipital pain and decreased cervical rotation without neurological deficit. The diagnosis of unilateral C1-C2 osteoarthritis was confirmed by an open-mouth radiograph, a bone-scan, a computerised tomography scan, and magnetic resonance imaging. C1-C2 fusion was performed using a computer assisted navigation system and posterior instrumentation. This resulted in marked relief of pain, and distinct improvement in quality of life. The prevalence of atlantoaxial osteoarthritis is about four per cent in patients suffering from peripheral or spinal osteoarthritis. However, many primary-care providers are not familiar with this entity. C1-C2 fusion remains rare, due to the difficulties related to the diagnosis of atlantoaxial osteoarthritis, its established non-operative treatment options, and the fact that it has not received adequate attention in the orthopaedic literature. However, based on review of the literature, it can be stated that C1-C2 fusion is an effective and safe procedure providing distinct reduction of pain and increased quality of life in case of failure of conservative treatment.