Artritis Reumatoide con sub luxacion atlantoaxoidea: ¿es siempre necesaria la odontoidectomia? / Rheumatoid arthritis with atlantoaxial subluxation: is odontoidectomy always necessary?

ABSTRACT

Objective: to describe 3 cases of atlantoaxial irreductible subluxations (AIS) in rheumatoid arthritis (RA) and to determine the need of an odontoidectomy. Description: case 1 (60 years, female) had a chronic cervical myelopathy; case 2 (46 years, male) had and acute transitory postraumatic cervical myelopathy and case 3 had local cervical pain. Intervention: in case 1 we resected the anterior arc of C1, the pannus and the odontoid. The subluxation was reduced and a posterior occipitocervical fixation (POC) was performed. In case 2 the resection included the anterior arc of C1, the pannus and the odontoid partially because the dura was opened accidentally with the drill. In spite of it the subluxation was reduced and a POC was done. In case 3 the resection was limited to the anterior arc of the atlas and the pannus. The subluxation was reduced and a POC was performed. Conclusion: in cases of AIS with superior migration of the odontoid or retro - odontoid pannus, odontoidectomy must be performed but in cases with pre - odontoid pannus, odointoidectomy can be avoided