Cervical Myelopathy Secondary to Bilateral Atlantoaxial Pseudoarticulations in Rheumatoid Arthritis: A Case Report

<h3>Background</h3> Cervical myelopathy caused by pseudarthroses is rare, with the exact pathophysiology of its occurrence unclear and reports scarce. To the best of our knowledge, only a few cases have been reported so far. We present a case of cervical myelopathy secondary to bilateral pseudoarticulations in rheumatoid arthritis and discuss possible pathomechanisms with reference to previously published reports. <h3>Case Presentation</h3> A 61-year-old woman with rheumatoid arthritis and previous C1 to C2 laminectomy suffered from cervical myelopathy. On preoperative imaging as well as surgical exploration, large osteophytes from bilateral pseudoarticulations between the posterior arches of the atlas and axis were seen to be causing severe compression of the spinal cord. <h3>Case Management</h3> Posterior instrumented C1 to C2 fusion with patient-specific pedicle screws and surgical planning was performed. The patient had significant clinical improvement after fusion. <h3>Conclusions</h3> Ligamentous laxity in rheumatoid arthritis can lead to the development of pseudoarticulations, with dynamic forces of neck motion causing osteophytic bony spurs and cord compression. Posterior decompression and fusion was effective in this case of bilateral pseudoarticulations, which produced a posterolateral or “lateral recess” pattern of cord compression refractory to previous central decompression alone. <h3>Level of Evidence</h3> 5.