Predictors of Paralysis in the Rheumatoid Cervical Spine in Patients Undergoing Total Joint Arthroplasty

Grauer, Jonathan N.; Tingstad, Edwin M.; Rand, Nahshon; Christie, Michael J.; Hilibrand, Alan S.

doi:10.2106/00004623-200407000-00009

Cited by 20 publications

(8 citation statements)

References 11 publications

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“…Previous joint surgery was a marginally significant predictor; a high prevalence of cervical spine instabilities in RA patients undergoing joint surgery is often reported [14], [22], [37], [38]. Based on the ORs and 95% CIs of these variables, we propose that RA patients not only with mutilating changes but also with stage III or IV and severe disease activity—long-term corticosteroid administration and/or previous joint surgery—should receive radiological follow-up in the cervical spine.…”

Section: Discussionmentioning

confidence: 99%

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Accelerated Development of Cervical Spine Instabilities in Rheumatoid Arthritis: A Prospective Minimum 5-Year Cohort Study

et al. 2014

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ObjectiveTo clarify the incidence and predictive risk factors of cervical spine instabilities which may induce compression myelopathy in patients with rheumatoid arthritis (RA).MethodsThree types of cervical spine instability were radiographically categorized into “moderate” and “severe” based on atlantoaxial subluxation (AAS: atlantodental interval >3 mm versus ≥10 mm), vertical subluxation (VS: Ranawat value <13 mm versus ≤10 mm), and subaxial subluxation (SAS: irreducible translation ≥2 mm versus ≥4 mm or at multiple). 228 “definite” or “classical” RA patients (140 without instability and 88 with “moderate” instability) were prospectively followed for >5 years. The endpoint incidence of “severe” instabilities and predictors for “severe” instability were determined.ResultsPatients with baseline “moderate” instability, including all sub-groups (AAS+ [VS− SAS−], VS+ [SAS− AAS±], and SAS+ [AAS± VS±]), developed “severe” instabilities more frequently (33.3% with AAS+, 75.0% with VS+, and 42.9% with SAS+) than those initially without instability (12.9%; p<0.003, p<0.003, and p = 0.061, respectively). The incidence of cervical canal stenosis and/or basilar invagination was also higher in patients with initial instability (17.5% with AAS+, 37.5% with VS+, and 14.3% with SAS+) than in those without instability (7.1%; p = 0.028, p<0.003, and p = 0.427, respectively). Multivariable logistic regression analysis identified corticosteroid administration, Steinbrocker stage III or IV at baseline, mutilating changes at baseline, and the development of mutilans during the follow-up period correlated with the progression to “severe” instability (p<0.05).ConclusionsThis prospective cohort study demonstrates accelerated development of cervical spine involvement in RA patients with pre-existing instability—especially VS. Advanced peripheral erosiveness and concomitant corticosteroid treatment are indicators for poor prognosis of the cervical spine in RA.

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Section: Discussionmentioning

confidence: 99%

“…Patient age (<55 [11], [15] and ≥65 [36] years), sex (male [6], [9]), the duration of RA (≥15 years [11]), and previous joint surgery for RA [14], [22], [37], [38] were recorded at baseline. In addition, each patient's follow-up period was compared with the mean duration of 6.0 years.…”

Section: Methodsmentioning

confidence: 99%

Accelerated Development of Cervical Spine Instabilities in Rheumatoid Arthritis: A Prospective Minimum 5-Year Cohort Study

et al. 2014

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“…In a recent study by Grauer et al,19 the prevalence of cervical spine instability was 41% in rheumatoid patients who had undergone total knee or hip replacement. In a study by Collins et al,16 50% of the patients with cervical spine subluxation had no signs or symptoms of it.…”

mentioning

confidence: 92%

High prevalence of asymptomatic cervical spine subluxation in patients with rheumatoid arthritis waiting for orthopaedic surgery

Neva

2005

Annals of the Rheumatic Diseases

115

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Objective: To study the prevalence of cervical spine subluxation in patients with rheumatoid arthritis waiting for orthopaedic surgery, and symptoms that might be associated with the disorders. Methods: 194 patients with rheumatoid arthritis were referred for orthopaedic surgery at Jyväskylä Central Hospital, 154 (79%) of whom volunteered for the present study including clinical examination, laboratory tests, radiographs of the cervical spine, hands, and feet, and self report questionnaires. Definition of anterior atlantoaxial subluxation (aAAS) was .3 mm and of subaxial subluxation (SAS) >3 mm. Atlantoaxial impaction (AAI) was analysed following to the Sakaguchi-Kauppi method. Results: 67 patients (44%) had cervical spine subluxation or previous surgical fusion. The prevalence of aAAS, AAI, SAS, or previous fusion was 27 (18%), 24 (16%), 29 (19%), and 8 (5%), respectively; 69% of patients with cervical spine subluxations (those with fusions excluded) reported neck pain, compared with 65% of patients without subluxations (p = 0.71). The prevalence of occipital, temporal, retro-orbital, and radicular pain in upper extremities was similar in patients with or without cervical spine subluxations (54% v 43%; 17% v 31%; 25% v 24%; 47% v 48%, respectively). However, patients with subluxations were older, had longer disease duration, more active disease, poorer function according to the Health Assessment Questionnaire, and had more often erosive disease. Conclusions: Asymptomatic cervical spine subluxation is common in patients with rheumatoid arthritis waiting for orthopaedic surgery. Regardless of symptoms, the possibility of cervical spine subluxation in patients with severe rheumatoid arthritis should be considered in preoperative evaluation.

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“…Grauer et al retrospectively found that four of 65 (8%) patients who underwent a total hip or knee arthroplasty had radiographic signs that were predictive of paralysis, as defined by Boden (PADI or SAC < 14 mm) 21 compared with the 20 (41%) patients with traditional radiographic evidence of instability (AADI > 3 mm or SAS > 3 mm). 28 Although there is some variability of the reported incidence of cervical instability in this population, these studies do emphasize the importance of preoperative screening films in rheumatoid patients who are to undergo endotracheal intubation.…”

Section: ■ Backgroundmentioning

confidence: 89%

13 Subaxial Subluxation of the Rheumatoid Cervical Spine

Albert¹,

Lee²,

Lim³

2008

Cervical Spine Surgery Challenges

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Predictors of Paralysis in the Rheumatoid Cervical Spine in Patients Undergoing Total Joint Arthroplasty

Cited by 20 publications

References 11 publications

Accelerated Development of Cervical Spine Instabilities in Rheumatoid Arthritis: A Prospective Minimum 5-Year Cohort Study

Accelerated Development of Cervical Spine Instabilities in Rheumatoid Arthritis: A Prospective Minimum 5-Year Cohort Study

High prevalence of asymptomatic cervical spine subluxation in patients with rheumatoid arthritis waiting for orthopaedic surgery

13 Subaxial Subluxation of the Rheumatoid Cervical Spine

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