# Surgical treatment and clinical outcome in non-inflammatory atlantoaxial degeneration and retro-odontoid pseudotumor

## TL;DR

Surgical fusion of C1-2 improves neck pain and spinal cord issues in non-inflammatory atlantoaxial degeneration.

## Contribution

Demonstrates effectiveness of C1-2 fusion for non-inflammatory atlantoaxial degeneration without autoimmune causes.

## Key findings

- C1-2 fusion significantly improved mJOA scores and pain relief in most patients.
- Degenerative masses did not regress after surgery, unlike inflammatory pannus.
- Additional decompression improved outcomes for patients with myelopathy.

## Abstract

Patients suffering from atlantoaxial degeneration with spinal cord compression may suffer from burdening neck pain and myelopathy, reducing their mobility and quality of life. Formerly known as a distinct entity in rheumatoid arthritis, atlantoaxial degenerative arthrosis with or without atlantoaxial instability and spinal cord compression may occur without being caused by autoimmune or inflammatory factors.

This study aims to evaluate the outcome of C1-2 fusion in patients with atlantoaxial degeneration.

We retrospectively assessed patients undergoing C1-2 stabilization for symptoms and radiographical signs of atlantoaxial degeneration with or without a retrodental mass in our neurosurgical department from January 2012 to December 2023. Patients with inflammatory and autoimmune diseases were excluded. Radiological parameters, surgical data, and clinical follow-up data were retrieved from our records to investigate the clinical outcome.

We included 43 patients suffering from refractory neck pain and/or myelopathy for further analysis. The mean age was 73 years. All patients underwent C1-2 fixation and 60.5 % obtained a decompression via C1 laminectomy for myelopathy. Median mJOA score improved significantly from 12/18 preoperatively to 14/18 at a median follow-up of nine months. The mean preoperative atlantodental distance was 2.5 mm. In total, pain relief was achieved in 93.5 % of the patients, and 90.5 % of the patients with preoperative myelopathy improved on the mJOA scale at follow-up.

C1-2 fusion achieved satisfying results in patients suffering from non-inflammatory atlantoaxial degeneration. Patients suffering from neck pain and symptoms of myelopathy improved until follow-up with the posterior approach.

•C1-2 fusion improves myelopathy and neck pain in atlantoaxial degeneration.•Degenerative mass does not regress after fixation, unlike inflammatory pannus.•Additional decompression improves neurological outcomes in selected patients.

C1-2 fusion improves myelopathy and neck pain in atlantoaxial degeneration.

Degenerative mass does not regress after fixation, unlike inflammatory pannus.

Additional decompression improves neurological outcomes in selected patients.