Results of a Longer Than 10-Year Follow-Up of Patients With Rheumatoid Arthritis Treated by Occipitocervical Fusion

Matsunaga, Shunji; Ijiri, Kousei; Koga, Hiroaki

doi:10.1097/00007632-200007150-00002

Cited by 69 publications

(47 citation statements)

References 21 publications

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“…The incidence of subaxial subluxation was low, corresponding to the 17% of the treated patients. If we consider, however, that such occurrence was reported just in the group of patients affected by rheumatoid arthritis, this value raises to 30% and it is in concordance with the literature [5,8]. The absence of this complication in tumoral pathology is probably related to the limited survival period of these patients which generally does not allow for a long followup.…”

Section: Discussionsupporting

confidence: 83%

“…Several reports exist about the significance of rheumatoid arthritis in the pathogenesis of atloaxial and subaxial instability. Matsunaga et al [8] reported an incidence of subluxation of 34% on a series of patients affected by rheumatoid arthritis in advanced disease. Kraus et al [5] reported an incidence of 36% in a similar series.…”

Section: Discussionmentioning

confidence: 99%

“…Most common pathology was rheumatoid arthritis (27 cases), following traumas (9), tumours (8), congenital malformations (6). At clinical presentation, the patient exhibited, in the majority of cases, cervical pain, associated or not with myelopathy.…”

Section: Methodsmentioning

confidence: 99%

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Relevance of the cranioaxial angle in the occipitocervical stabilization using an original construct: a retrospective study on 50 patients

2009

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We present a retrospective study on a series composed of 50 patients, treated between 1992 and 2006, affected by pathologies of the craniocervical junction. All the patients were treated using an innovative procedure based on a cranial claw made up of low profile hooks, conceived by one of the authors. Advantages of this technique are, to our point of view, a higher resistance to cranial hooks dislodgment, when compared with screw fixation instrumentation, especially in pathological conditions, such as rheumatoid arthritis that leads to a qualitative deterioration of the bone stock and to the reduction of the occipital wall thickness. Occipitoaxial alignment was assessed radiographically using the McGregor line. We observed an improvement in the subjective evaluation of pain in all treated patients with a 46% improvement from the initial values. Moreover, patient stabilized with an occipitoaxial angle included in the physiological range showed better results either for the survival of the instrumentation or the onset of junctional pathology. Patients have been followed up afterwards and evaluated by the visual analogue scale for the assessment of pain and by the Nurick scale for the cases associated with myelopathy. We believe that cranial anchorage with a hook claw allows for an instrumentation provided with high stability, particularly useful in revision surgery and major instabilities. The study of the occipitoaxial angles showed that the better results and the long-lasting stability of the implant are correlated to a fusion angle included in the physiological range.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

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Relevance of the cranioaxial angle in the occipitocervical stabilization using an original construct: a retrospective study on 50 patients

2009

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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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“…Subaxiale Anschlussinstabilitäten sind bei der RA ein häufiges Problem und treten deshalb zunehmend in den Blickpunkt des Interesses [19,30,[32][33][34] Es sollte deshalb bereits in der primären OP-Planung gezielt nach einer segmentalen subaxialen Problematik gesucht werden (z. B. segmentale Gleitbewegung, Malalignment in Lordose oder inflammatorische Prozesse).…”

Section: N Atlantoaxiale Fusionunclassified

Therapie der zervikalen rheumatoiden Arthritis

2004

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The rheumatoid involvement of the cervical spine can be divided into three phases. In the early stage of the disease there is an isolated atlantoaxial subluxation (AAS), followed by vertical instability and subaxial instability. If patients show clear symptoms of cervical myelopathy, which can occur during any stage of the disease, the progression cannot be stopped by conservative treatment, which is of great importance at the beginning of the cervical manifestation. Patient education, physiotherapy and immobilization with a stiff collar can significantly reduce pain. Early and effective DMARD therapy can have a positive effect on the natural history of the disease. In case of progressive instability, cervical myelopathy or severe pain operative treatment is indicated. If there is an isolated AAS, fusion can be restricted to the C1/C2 segment. The Magerl transarticular screw fixation is the preferred technique for stabilization. If there is evidence for vertical instability or severe destruction of the C0/C1 joints, occipital cervical fusion has to be performed. Durin the preoperative planning it is necessary to look for signs of subaxial instability. If this is the case, fusion should include the entire cervical spine. Transoral decompression may be necessary when there is persistent anterior compression of the myelon, typically seen in fixed AAS. Non-ambulatory myelopathic patients are more likely to develop severe surgical complications. Therefore, it is important to avoid the development of severe cervical instability by early surgical intervention. The right timing for surgery is still a matter of controversy. Future prospective randomized trials should address this topic to improve the treatment concept for the rheumatoid patient.

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Results of a Longer Than 10-Year Follow-Up of Patients With Rheumatoid Arthritis Treated by Occipitocervical Fusion

Abstract: Occipitocervical fusion for patients with rheumatoid arthritis is useful for decreasing nuchal pain, reducing myelopathy, and improving prognosis.

Cited by 69 publications

References 21 publications

Relevance of the cranioaxial angle in the occipitocervical stabilization using an original construct: a retrospective study on 50 patients

Relevance of the cranioaxial angle in the occipitocervical stabilization using an original construct: a retrospective study on 50 patients

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

Therapie der zervikalen rheumatoiden Arthritis

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