Clinical Course of Conservatively Managed Rheumatoid Arthritis Patients With Myelopathy

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

doi:10.1097/00007632-199711150-00004

Cited by 97 publications

(53 citation statements)

References 32 publications

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“…A recent study indicated that the natural course of RA patients with myelopathy managed by conservative treatments is poor [25]. In their study, all patients did not recover and were bedridden.…”

Section: Discussionmentioning

confidence: 92%

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Computer-assisted screw insertion for cervical disorders in rheumatoid arthritis

et al. 2006

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To reconstruct highly destructed unstable rheumatoid arthritis (RA) cervical lesions, the authors have been using C1/2 transarticular and cervical pedicle screw fixations. Pedicle screw fixation and C1/2 transarticular screw fixation are biomechanically superior to other fixation techniques for RA patients. However, due to severe spinal deformity and small anatomical size of the vertebra, including the lateral mass and pedicle, in the most RA cervical lesions, these screw fixation procedures are technically demanding and pose the potential risk of neurovascular injuries. The purpose of this study was to evaluate the accuracy and safety of cervical pedicle screw insertion to the deformed, fragile, and small RA spine lesions using computer-assisted image-guidance systems. A frameless, stereotactic image-guidance system that is CT-based, and optoelectronic was used for correct screw placement. A total of 21 patients (16 females, 5 males) with cervical disorders due to RA were surgically treated using the image-guidance system. Postoperative computerized tomography and plane X-ray was used to determine the accuracy of the screw placement. Neural and vascular complications associated with screw insertion and postoperative neural recovery were evaluated. Postoperative radiological evaluations revealed that only 1 (2.1%; C4) of 48 screws inserted into the cervical pedicle had perforated the vertebral artery canal more than 25% (critical breach). However, no neurovascular complications were observed. According to Ranawat's classification, 9 patients remained the same, and 12 patients showed improvement. Instrumentation failure, loss of reduction, or nonunion was not observed at the final followup (average 49.5 months; range 24-96 months). In this study, the authors demonstrated that image-guidance systems could be applied safely to the cervical lesions caused by RA. Image-guidance systems are useful tools in preoperative planning and in transarticular or transpedicular screw placement in the cervical spine of RA patients.

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Section: Discussionmentioning

confidence: 92%

“…In their study, all patients did not recover and were bedridden. Furthermore, all patients had died within 3 years [25]. Casey [5] reported that no benefit was obtained except pain relief by surgical treatment of patients of Ranawat's class 3B.…”

Section: Discussionmentioning

confidence: 99%

Computer-assisted screw insertion for cervical disorders in rheumatoid arthritis

et al. 2006

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“…However, the natural course of conservative therapy for RA patients accompanied with myelopathy is unfavorable and reported to result in persistent paralysis and bedridden state [20].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of clinical results and quality of life after surgical reconstruction for rheumatoid cervical spine

et al. 2013

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“…Decompression and fusion (including OFT) surgery in this type of rheumatoid patient has been shown to be beneficial in maintaining or improving the quality of life [1,2,7,8,10,11]. One of the technical advantages for the use of contemporary occipito-cervical rod-screw instrumentation is that an additional external brace such as a Halo-Vest is not necessary [3,[6][7][8]11].…”

Section: Discussionmentioning

confidence: 99%

Mediastinal migration of distal occipito-thoracic instrumentation

2007

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We present the occurrence and management of mediastinal migration of the distal aspect of a posterior occipito-thoracic screw-rod construct. No similar occurrence was found in the literature. This event occurred following an emergency tracheotomy (requiring neck hyperextension) in a patient with severe rheumatoid arthritis, who had previously undergone decompression and an Occiput-T2 instrumented fusion for cranio-cervical and sub-axial cervical spine instability. Imaging showed fracture-subluxation of T1/2 and T2/3 with the bilateral C7, T1 and T2 screws in the mediastinum causing tracheal and esophageal compression. Removal of the instrumentation, decompression (T2 corpectomy) and construct revision down to T10 was safely performed from a posterior approach. Severe osteoporosis, some pre-existing screw loosening and hyperextension of the neck were the predisposing factors of this near catastrophic event. By staying directly posterior to the rod and following the fibrous tract already created, the instrumentation was safely removed from the mediastinum.

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Clinical Course of Conservatively Managed Rheumatoid Arthritis Patients With Myelopathy

Abstract: The clinical results for rheumatoid arthritis patients with myelopathy treated without surgery are extremely poor. Surgical treatment is recommended for rheumatoid arthritis patients with myelopathy.

Cited by 97 publications

References 32 publications

Computer-assisted screw insertion for cervical disorders in rheumatoid arthritis

Computer-assisted screw insertion for cervical disorders in rheumatoid arthritis

Evaluation of clinical results and quality of life after surgical reconstruction for rheumatoid cervical spine

Mediastinal migration of distal occipito-thoracic instrumentation

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