Computer-assisted screw insertion for cervical disorders in rheumatoid arthritis

Abstract

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.

Anterior cervical pedicle screw and plate fixation using fluoroscope-assisted pedicle axis view imaging: a preliminary report of a new cervical reconstruction technique

“…In our experience of PPS procedures, critical breaches were seen in 17 (4.0%) of 419 screws [32], and all these displaced screws were clinically silent. Although the neurovascular surroundings of cervical pedicles allow for some safety margin, with most pedicle wall perforations being non-critical [9,10,12,27,31], the potentially fatal consequences of neurovascular injury during APS insertion remain a serious concern. Injury to the vertebral artery may cause cerebral infarction or death.…”

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

“…The following surgical procedures were performed: C1-C2 transarticular screw fixation (Magerl and Brooks procedure) [10] in AAS patients and cervicothoracic fusion using transpedicular screws in subaxial subluxation and occipitocervical or occipitothoracic fusion in AAS, vertical subluxation, and subaxial subluxation patients [9].…”

“…The EuroQol-5D questionnaire (EQ-5D) is a widely used comprehensive measurement of health-related QOL and can be used to generate a single index value or utility [8,9]. The EQ-5D is used in various patient groups including those with spine diseases.…”

Mid-term results of computer-assisted cervical reconstruction for rheumatoid cervical spines

“…The following surgical procedures were performed: C1-C2 transarticular screw fixation (Magerl and Brooks procedure; Trans Bone Screw; KiscoMedica, St Priest, France) [9] in patients with AAS, and occipitocervical or occipitothoracic fusion using the Olerud cervical system (Nord Opedic, Askim, Sweden) or RRS Loop Spinal System (Robert Leid, Tokyo, Japan) in those with AAS, VS, or AAS + VS + SAS [8]. We performed C1-C2 transarticular screw fixation (Magerl and Brooks procedure) for EuroQol (EQ-5D) utility weight [12] were used for the clinical evaluation of cervical disorders with RA before surgery and at 2 and 5 years after surgery.…”

“…We have reported good results of surgical reconstruction using this method, 2 years post surgery [8]. However, there is little data on mid-term results (>5 years of follow up) of surgical reconstruction for rheumatoid cervical disorders, particularly, cervical pedicle screw fixation.…”