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

Park, Sung Choon; Oh, Seong Hoon; Rim, Dae Cheol; Yoo, Dae Hyun; Chae, Euy Byung; Kim, Nam Kyu

Case Report

Journal of Korean Neurosurgical Society 1999;28(7): 1023-1026.

Sung Choon Park, Seong Hoon Oh, Dae Cheol Rim, Dae Hyun Yoo, Euy Byung Chae, Nam Kyu Kim

¹Department of Neurosurgery, Myongji Hospital, Kwandong University, Koyang, Korea.
²Department of Neurosurgery, School of Medicine, Hanyang University, Seoul, Korea.
³Department of Rheumatology, School of Medicine, Hanyang University, Seoul, Korea.

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.

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