Adult Atlantoaxial Subluxation in Post COVID-19 Recovery: A Case Series

Background: Non-traumatic atlantoaxial subluxation in adults is a rare condition usually common in patients with rheumatoid arthritis, and infection of the upper respiratory tract is also considered to be a trigger of inflammation and laxity of ligaments and further subluxation. to date there have been some reported cases of atlantoaxial as complication of COVID-19. Diagnosis and management of atlantoaxial subluxation is currently based on x-ray with special views. Therefore, it is important to early diagnosis and treating adult patients suffering from neck pain and stiffness as a suspected case of nontraumatic atlantoaxial subluxation. Case reports: In this case series, we reported 17 healthy elderly patients (11 male and 6 female) who had atlantoaxial subluxation after a mild (8 patients 4 male and 4 female) and 9 moderate cases (6 males with 3 females) of COVID-19. The patients had neck pain (pain score ranged 6 to9 wit mean 7,5), occipital headache (7 patient with severe and moderate occipital headache with only 3 with mild), and stiffness with different levels of limitation of cervical movements after recovering from Covid-19 in varying periods between 3 and 7 months. Conservative treatment included antibiotics; non-steroid anti-inflammatory agents, short course of corticosteroids, and immobilization with soft cervical collar followed by physiotherapy after pain subsided was done for the patients, and the clinical recovery observed within 8-10 weeks with good results in 10 patients with relieving pain and restoring the cervical motion to the normal, and 7 patients with acceptable result of treatment with slight limitation of cervical movements. Conclusion: As atlantoaxial subluxation in adult patients may be a late complication of COVID-19, more research is needed to determine the specific association between COVID-19 and atlantoaxial subluxation in adults.