Upward subluxation of the axis in ankylosing spondylitis

Craniocervical junction involvement in ankylosing spondylitis

“…Previous studies, based on the conventional radiography, had reported changes in the atlantodental articulation, such as fusion and subluxation, as the most frequent forms of CCJ involvement by AS [9,10]. Pathologic alterations of atlanto-occipital joints and ligaments had been only rarely mentioned in the literature [11,12]. The present study, based on CT findings, suggests that the distribution of CCJ involvement in patients with AS may be different than appreciated heretofore, developing also in AS patients without obvious syndesmophytes.…”

Ankylosing spondylitis of the craniovertebral junction: a single surgeon's experience

“…Three of these patients underwent traction prior to surgery. [3][4][5][6][7]11,13,14,[18][19][20][21][22]28,31,33,34,36,37 One of the patients in this series had an odontoid fracture as his primary pathology at the CVJ. Multiple case reports have documented the occurrence of odontoid fractures in patients with ankylosing spondylitis.…”

“…[3][4][5]7,8,10,11,13,14,[19][20][21][22]28,31,33,34,36,37 In addition, erosion of the C1-2 facet joints, 4,10,14,18 erosion of the lateral mass of C-1, 6,10,19 erosion of the anterior arch of C-1 and/or odontoid process of C-2, 10,21,22 hypertrophy of the odontoid process, 21 and varying degrees of spontaneous fusion of the occiput, C-1, and C-2 19,21,22,28,33 have been reported. Our patients demonstrated a similar spectrum of radiographic findings.…”

“…20 A recent case-control series comparing the facet joints of patients with ankylosing spondylitis to tissue from normal controls obtained at autopsy demonstrated inflammatory infiltrates in the affected joints. 1 Little et al 19 reported on the autopsy findings of a patient with CVJ pathology due to ankylosing spondylitis. They identified fusion of the anterior arch of C-1 to the dens, disruption of the posterior arch of C-1 from the C-1 body, and replacement of the lateral masses of C-1 with fusion masses extending from the occiput to C-2.…”

“…16,17,21,29,35,38 Most reports detailing the presentation and treatment of CVJ disease and ankylosing spondylitis are limited to case reports and small case series. [3][4][5][6]11,13,14,[18][19][20][21][22]28,31,33,34,36,37 In 1961, Sharp and Purser 32 reported on 22 patients with ankylosing spondylitis and atlantoaxial subluxation. Among these patients, the most common presenting signs and symptoms were pain, occipitocervical deformity, and neurological deficits.…”