Posterior Only Reduction and Fixation of The Basilar Invagination and Atlantoaxial Dislocation Secondary to Severe Rheumatoid Arthritis: A Technical Note.

PURPOSE: Rheumatoid arthritis can significantly impact the craniocervical junction, leading to basilar invagination due to joint destruction and instability. Traditionally, such conditions may require anterior or more invasive surgical interventions, which pose greater risks, especially in immunocompromised patients. This study introduces a less invasive, posterior-only method that can be executed even in resource-limited settings.

METHODS

The case study involves a 45-year-old woman with severe rheumatoid arthritis and neurological symptoms due to basilar invagination. The surgical approach included decompression by resection of the foramen magnum and C1 posterior arch, followed by stabilization using an occipital plate, pedicular screws at C3 and C4, and an expandable mesh cage between the occipital condyle and C3 superior articular process. This procedure aimed to achieve decompression and stabilization while being monitored with intraoperative neuromonitoring.

RESULTS

The patient experienced significant postoperative improvement with increased neurological function, resolution of instability and dysphagia, and no new neurological deficits. Imaging showed Improved brainstem alignment and increasedCSF cushioning. The technique provided effective neural decompression and mechanical stabilization with minimal anatomical alteration.

CONCLUSION

The described posterior-only approach offers a viable and less invasive alternative for treating basilar invagination in rheumatoid arthritis patients. It provides substantial neurological and mechanical benefits while being accessible in various healthcare settings due to its reliance on familiar surgical techniques. Further studies are needed to evaluate the long-term outcomes and potential applications in other pathologies affecting the craniocervical junction.