3??? to 11-Year Followup of Occipitocervical Fusion for Rheumatoid Arthritis

Mori, Teruo; Matsunaga, Shunji; Sunahara, Nobuhiko; Sakou, Takashi

doi:10.1097/00003086-199806000-00020

Cited by 34 publications

(17 citation statements)

References 43 publications

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“…Several studies have reported that, in operated patients, additional long fusion surgery have been caused by newly developed instability and decompensation of the adjacent segments after the atlanto-axial or occipito-cervical fusions [9][10][11][12][13][14]. Newly developed subluxation below a fused segment may occur in 20-36 % of RA patients after cervical fusion [12][13][14].…”

Section: Discussionmentioning

confidence: 99%

Adjacent-level failures after occipito-thoracic fusion for rheumatoid cervical disorders

Tanouchi¹,

Shimizu²,

Fueki³

et al. 2013

Eur Spine J

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Introduction The natural history of cervical spine lesions in rheumatoid arthritis (RA) is variable. We have actively performed occipito-thoracic fusion for severe destructive rheumatoid cervical disorders and reported its clinical results and complications. In our previous study, the most frequent complication was the adjacent-level failures caused by the fragile spine. The objective of this study was to determine risk factors for adjacent-level failures after occipito-thoracic fusion. Materials and Methods Subjects were 35 RA patients (31 females and 4 males) who underwent occipito-thoracic fusion using RRS Loop Spinal System Ò (Robert Reid Inc. Tokyo, Japan), and the incidence and characteristics of adjacent-level failures were investigated. Furthermore, the adjacent-level failures were divided into two types according to their levels, fracture at the lowest level of the fusion area and that at the level inferior to the fusion area, and the characteristics of each type were evaluated. Results and Conclusion Nine (26 %) of 35 patients suffered adjacent-level failures (10 vertebral fractures). Adjacent-level failures occurred when the distance of fixation was ''O-T4'' or longer. The long fusion might cause adjacentlevel failures due to greater mechanical stress. Seven fractures occurred at the lowest level of the fusion area, and all of them were cured without symptoms by conservative treatment. Three fractures occurred at the level inferior to the fusion area, and one of them needed additional surgery due to sudden paraplegia resulting from collapse of the adjacent vertebra. After occipito-thoracic fusion, burst fractures at the level inferior to the fusion area might cause sudden paraplegia, and therefore a careful observation should be required for patients with these fractures.

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Section: Discussionmentioning

confidence: 99%

Adjacent-level failures after occipito-thoracic fusion for rheumatoid cervical disorders

Tanouchi¹,

Shimizu²,

Fueki³

et al. 2013

Eur Spine J

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“…Die Frage der Operation bei ZM, ob bei RA-ZM oder SC-ZM, wird überwiegend positiv betrachtet, zeigen doch die meisten Studien nach der Operation eine Verbesserung [2,7,19,35,36,46,57,68,82,87,90,104,105,117,139,156]. Umgekehrt ist die Prognose bei manifester RA-ZM und konservativem Vorgehen hinsichtlich Fortschreiten der Tetraparese und quoad vitam schlecht [7, 45,128].…”

Section: Outcomeunclassified

Die Zervikale Myelopathie als Komplikation der Rheumatoiden Arthritis

Arlt

Steinmetz

2004

Z Rheumatol

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Arthritis of the cervical spine with instability of the atlantodental joint is a typical and frequent complicaiton in rheumatoid arthritis. Subsequent cervical myelopathy is rare but usually a severe complication. There is no stringent correlation between arthritis of cervical spine an occurrence of cervical myelopathy. Cervical myelopathy is often difficult to discern from parallel multilating peripheral joint damage, which makes the diagnosis difficult. The decision between conservative and operative therapeutic intervention has to be based on subtle clinical, neurophysiological and radiological assessment and-in particular-requires exact analysis of the course of the underlying rheumatoid arthritis and myelopathy. In this diagnostic process close collaboration of rheumatologist, surgeon and neurologist is essential.

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“…When the tip of the odontoid is fused to the clivus, an occipitocervical (oc) fusion must occur, as persistent oc movement will still compress the brain stem [10]. Unless the C1-2 articulation is packed with allograft or autograft bone, it is difficult to conceive that mere immobilization of the facet joint will cause it to arthrodese, and particularly, when the posterior arches of C1, C2 and C3 have been removed and an oc is the better surgical solution [11,12]. This is further complicated and compromised by the patient's smoking history.…”

Section: Introductionmentioning

confidence: 99%

Expert’s comment concerning Grand Rounds case entitled “Transarticular fusion for treatment of cystic lesion arising from an odontoid fracture” (by Ruth M. Parks, Matthias A. König, Bronek Boszczyk and Masood Shafafy)

Goytan

2012

Eur Spine J

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3??? to 11-Year Followup of Occipitocervical Fusion for Rheumatoid Arthritis

Cited by 34 publications

References 43 publications

Adjacent-level failures after occipito-thoracic fusion for rheumatoid cervical disorders

Adjacent-level failures after occipito-thoracic fusion for rheumatoid cervical disorders

Die Zervikale Myelopathie als Komplikation der Rheumatoiden Arthritis

Expert’s comment concerning Grand Rounds case entitled “Transarticular fusion for treatment of cystic lesion arising from an odontoid fracture” (by Ruth M. Parks, Matthias A. König, Bronek Boszczyk and Masood Shafafy)

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