A 42-year-old woman with 15-year history of rheumatoid arthritis has C1-C2 subluxation of 10 mm on lateral cervical spine flexion view. She has myelopathic signs. The surgical procedure of choice is:
- A Anterior C1 transverse ligament repair
- B Posterior C1-C2 fusion (Goel-Harms or Brooks technique) ✓
- C Odontoid peg resection via transoral approach
- D Cervical orthosis for 3 months and repeat X-ray
Explanation
Atlanto-axial subluxation in RA occurs due to transverse ligament destruction from synovitis. Atlanto-dens interval (ADI) >3 mm is abnormal; >9 mm indicates incompetence of all ligaments with risk of cord compression. Myelopathic signs indicate surgical urgency. The procedure of choice is posterior C1-C2 fusion using screw-rod constructs (Goel-Harms technique uses lateral mass screws at C1 and pedicle/pars screws at C2) providing rigid fixation with 95%+ fusion rates. Orthosis is inadequate for myelopathy and progressive instability. Transoral resection is only for irreducible vertical subluxation (cranial settling).
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.