Atlantoaxial Subluxation Related to Axial Spondylarthritis: A Case-Based Systematic Review

Abstract

Aim: Atlantoaxial dislocation is a loss of stability between the atlas and axis. It is rarely reported in patients with axial spondylarthritis. We present an axial spondylarthritis case revealed by atlantoaxial subluxation. Case Report: We report the case of a 30-year-old man diagnosed with ankylosing spondylitis (AS) after being admitted to our department for acute atlantoaxial subluxation-related symptoms. Methods: We conducted a literature review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the MEDLINE database, including case reports and case series of atlantoaxial dislocation in axial spondylarthritis patients. Results: We included 16 articles. There were 134 patients (including our case), mainly male (n=119). The mean age was 34.43±12.96 years. Atlantoaxial dislocation revealed axial spondylarthritis in 4 cases. The main clinical manifestations were neck pain (12 cases), limb weakness with numbness (7 cases), cervical range of motion limitation (6 cases), neck stiffness (4 cases), muscle dystonia (2 cases), and dyspnoea (1 case). Specific neurologic signs were found in 4 patients. The atlantoaxial dislocation was anterior in 118 cases, rotatory in 5 cases, lateral in 1 case, and posterior in 1 case. Surgical treatment was the preferred option in most cases, consisting of C1-C2 arthrodesis. Outcomes were not detailed in 121 cases and were favourable for the rest. Only one patient died following a recurrence of spinal cord compression. Conclusion: Physicians need to be aware of atlantoaxial dislocation, as it could lead to spinal cord compression, vascular compression, and other serious life-threatening complications that may require surgical management.