A Novel Technique for the Management of AtlantoAxial OsteoArthritis (AAOA)

Purpose: This study presents a conservative approach and a novel technique for managing Atlantoaxial Osteoarthritis (AAOA). The subaxial cervical joints have a five joint complex, while C1-C2 joint is a three joint structure which makes it undergo biomechnaically increased stress. Atlantoaxial Osteoarthritis (AAOA) is more commonly associated with the elderly age group, especially women. Most of these patients improve with conservative treatment, while few require surgical fixation. Materials and Methods: Three hundred thirty-eight patients were analysed from the database (2009 to 2018) with a minimum follow up of 18 months. All patients presented with unilateral sub-occipital neuralgia, unilateral restricted movement, C2 radiculopathy and no myelopathy. Diagnosis of AAOA with an open mouth AP radiograph is confirmatory. Dynamic radiographs were used to diagnose instability. CT Scan was done for pre-operative evaluation, and MRI was done to rule out sinister pathologies. Results: The average age of the patients was 65.2 years (41-84 years). The majority of the patients (177) were females working as housewives. Our study didn’t have any correlation with the lifting of heavy objects on the head. The majority of the patients were treated conservatively with a soft cervical collar, and they were asked to wear it throughout the day and night, every day for two months. Patients with no symptomatic relief after conservative treatment with collar were given an intra-articular injection or greater occipital nerve block (BR Dave’s Technique). Patients not responding to conservative management with persistent instability were treated with Surgical Fixation (Trans-articular/Harms-Goel). Conclusion: The primary management is with a cervical collar; Greater Occipital Nerve Block (BR Dave’s technique) or Intra-articular block provides excellent symptomatic relief. Keywords: Arthritis, Atlantoaxial, Nerve block, C1C2 instability, C1C2 fusion