Medical Student The Warren Alpert Medical School of Brown University Cranston, RI, US
Introduction: Atlantoaxial pseudoarticulation is an uncommon condition characterized by atypical joint formation at the C1-2 level, potentially causing significant neck pain, spinal cord compression, and progressive cervical myelopathy. This rare pathology, often congenital or acquired over time, presents a challenge in neurosurgical treatment, with existing options typically involving decompression with or without instrumented fixation or fusion. However, no reports to date have detailed a full endoscopic approach for resecting atlantoaxial pseudoarticulation. Here, we describe a novel, minimally invasive technique utilizing full endoscopy to resect a pseudoarticulation at C1-2, achieving successful spinal cord decompression.
Methods: A 44-year-old female presented with six months of progressive cervical myelopathy, marked by gait instability, right-sided weakness, and numbness. Imaging confirmed a pseudoarticulation at C1-2 with significant spinal cord compression. We opted for a full endoscopic approach for decompression. Under general anesthesia, a tubular retractor and endoscope were introduced into the right paraspinal region at C1-2. The joint was resected using a high-speed drill and pituitary graspers, with neuromonitoring throughout to ensure safety.
Results: Postoperatively, the patient exhibited rapid improvement in motor skills, stability, and sensation. Imaging confirmed successful decompression without complications, and she was discharged the day after surgery. At six-month follow-up, the patient reported a full resolution of preoperative symptoms, with no pain or additional deficits. Eighteen-month follow-up imaging showed stable decompression without recurrence of symptoms, though mild, intermittent numbness in the hands was noted.
Conclusion : This case represents the first documented application of a full endoscopic approach to treat C1-2 pseudoarticulation. The technique allowed for minimal invasiveness, avoiding muscle damage and fusion, while providing effective decompression and symptom resolution. Full endoscopic resection may thus offer a promising alternative for managing this challenging pathology, with reduced postoperative morbidity and enhanced recovery.
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