J Korean Neurosurg Soc.  1999 Jul;28(7):1023-1026.

Vertebral Artery Obstruction due to Anterior and Vertical Subluxation of Atlanto-Axial and Atlanto-Occipital Joint in Ankylosing Spondylitis

• Park SC
• Oh SH
• Rim DC
• Yoo DH
• Chae EB
• Kim NK

Abstract

OBJECTIVE
We report a case with a long-standing history of the ankylosing spondylitis(AS) who showed multiple cerebellar infarctions with bulbar symptom owing to vertebral artery obstruction, due to anterior and vertical subluxation of atlanto-axial and atlanto-occipital joint. CLINICAL PRESENTARION: An 51-year-old male patient with swallowing difficulty, tongue deviation to the left side and severe nuchal pain and rigidity is presented. INTERVENTION: After removal of posterior portion of foramen magnum, posterior portion of left transverse foramen of axis was decompressed.
CONCLUSIONS
Spontaneous anterior atlanto-axial subluxation occurs in patients with AS about 2% of presents with or without signs of spinal cord compression. Vertical subluxation occurs in 3-8% of patient with rheumatoid arthritis but it is an exceedingly rare complication of AS. Close observation and follow-up are needed in patients with AS and if subluxation occurs, good prognosis is anticipated using an early operative treatment.

Keyword

Ankylosing spondylitis; Atlanto-axial subluxation; Atlanto-occipital subluxation; Vertical subluxation; Vertebral artery obstrction

MeSH Terms

Arthritis, Rheumatoid
Atlanto-Occipital Joint*
Axis, Cervical Vertebra
Deglutition
Follow-Up Studies
Foramen Magnum
Humans
Infarction
Male
Middle Aged
Prognosis
Spinal Cord Compression
Spondylitis, Ankylosing*
Tongue
Vertebral Artery*