Atlanto-Axial Instability

A 61-year-old gentleman with rheumatoid arthritis presented with neck pain and gait instability. He also had clumsiness of hand movement and spasticity — signs of cervical myelopathy from upper cervical cord compression.

Investigations revealed instability between the first and second cervical vertebra (C1 and C2) causing dynamic compression of the cervical spinal cord. This is a known complication of rheumatoid arthritis where inflammatory destruction of the transverse ligament causes atlantoaxial subluxation.

C1-C2 stabilization and fusion were done using C1 lateral mass and C2 translaminar screw fixation. This technique provides strong fixation without requiring complex C2 pedicle screws, making it safer in this elderly patient with rheumatoid changes.

Postoperative CT scan and X-ray confirmed good C1-C2 reduction. Patients with rheumatoid arthritis can develop this type of cervical spine instability requiring surgical treatment when conservative measures fail.