Abstract

KUZLI, José et al. Atlantoaxial subluxation in rheumatoid arthritis. Resolution by endoscopic endonasal odontoidectomy and fusion and instrumentation by posterior approach. Case report. Rev. Nac. (Itauguá) [online]. 2024, vol.16, n.2, pp.145-154. ISSN 2072-8174.  https://doi.org/10.18004/rdn2024.may.02.145.154.

Atlantoaxial subluxation is the most common injury to the cervical spine caused by rheumatoid arthritis. It is manifested by neck stiffness, neck pain and neurological deficit. Diagnosis is made with computed tomography and magnetic resonance imaging. The anterior dental atlanto interval greater than 5mm indicates atlantoaxial instability, the posterior dental atlanto interval less than 14mm warns of neurological risk. The most frequent indications for surgery are: severe neck pain, instability and symptoms of myelopathy. When there is spinal cord compression, upper cervical decompression is necessary, either via a posterior or anterior approach (endonasal versus transoral odontoidectomy). The rhinopalatine line will indicate the feasibility of an endoscopic endonasal odontoidectomy (EEO). The objective of the presentation of this case is to share our experience with the first endoscopic endonasal odontoidectomy performed in our country and to promote the use of the technique. The surgery was performed on a patient with spastic quadriparesis due to atlantoaxial subluxation due to rheumatoid arthritis and who presented excellent postoperative evolution, with almost complete recovery. EEO is a minimally invasive surgical technique, ideal for patients with multiple comorbidities and offering good to excellent results.

Keywords : Cervical rheumatoid arthritis; endonasal odontoidectomy; atlantoaxial subluxation; atlantoaxial instability.

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