Atlantoaxial arthrodesis for vertebrobasilar insufficiency due to rheumatoid arthritis: A case report

Patients with rheumatoid arthritis often have involvement of the cervical spine, which may lead not only to impairment of activities of daily living but also to sudden death 1. Cervical instability secondary to rheumatoid arthritis is associated with compression myelopathy in many patients and with vertebrobasilar insufficiency in some patients. To our knowledge, this is the first report of the surgical treatment of vertebrobasilar insufficiency in a patient with rheumatoid atlantoaxial subluxation without evidence of a compression myelopathy. The subject of this case report was informed that data concerning the case would be submitted for publication. A woman was diagnosed with rheumatoid arthritis in 1982, at the age of forty-five years, and hemodialysis was begun in 1997 to treat chronic renal insufficiency. She was hospitalized repeatedly since 1998 because of difficulty walking due to arthritis of both hips and knees and, in 1998, she underwent a right total hip arthroplasty. Cervical pain developed in the spring of 1999. A diagnosis of atlantoaxial subluxation was made, and the patient wore a cervical collar to help control the pain. In the fall of 1999, she began experiencing neuralgia of the left greater occipital nerve when she extended the neck. At the same time, she had vertigo, a feeling of faintness, and slurred speech. These symptoms were transient and resolved shortly after their onset. In December 1999, the patient had a spontaneous seizure and was unconscious for approximately five minutes. After that episode, she could not speak clearly for several hours. She was examined for signs of cerebral infarction and underwent electroencephalography, the findings of which were reported to be normal. In June 2000, she lost consciousness again and had difficulty with her speech immediately thereafter; she …