脳神経外科速報

Abstract

Atlantoaxial osteoarthritis (AAOA) has been recognized as a distinct cause of occipitocervical pain in older adults. Recently, we experienced the case of a patient with AAOA accompanying occipital neuralgia (ON). Because of its rarity and difficulty in devising a treatment strategy, this case is reported alongside a review of literature. A 75-year-old woman presented with a 12-month history of electric shock-type pain radiating from the left suboccipital region to the vertex, which was aggravated by neck motion especially when the head was rotated to the left. She also complained of chronic left-sided neck pain, which developed 5 years before the onset of neuralgia. Her condition responded minimally to treatment with a soft collar and analgesic drugs. Under fluoroscopic control she underwent injection of local anesthetic and steroid agents to the C-2 nerve root, which provided immediate relief of electric shock-type pain for 5 days, although the effect was minimal for chronic neck pain. For this patient C2 neurectomy and C1-2 fusion was performed. Her postoperative course was favorable.