RESEARCH - Long-term incidence of subaxial cervical spine instability following cervical arthrodesis in RA

[Guest guest]

Surg Neurol. 2006 Aug;66(2):136-40; discussion 140.

Long-term incidence of subaxial cervical spine instability following

cervical arthrodesis surgery in patients with rheumatoid arthritis.

Department of Neurologic Surgery, Mayo Clinic and Mayo Foundation,

Rochester, MN 55902, USA. clarke.michelle@...

OBJECTIVE: Cervical spine deformities are well-known complications of RA. A

5- to 20-year follow-up of 51 consecutive rheumatoid patients who underwent

posterior cervical arthrodesis is presented to evaluate the recurrence of

instability and need for further surgery. METHODS: We conducted a

retrospective review of the clinical features of 11 men and 40 women with an

established diagnosis of RA and associated cervical deformities who

underwent cervical spine surgery at the Mayo Clinic (Rochester, MN) between

1979 and 1990. Their mean age was 61 +/- 10 years (SD), and their duration

of RA averaged 21 +/- 8.9 years (SD). There were 22 patients who presented

with myelopathy, 7 with radiculopathy, and 22 with instability/neck pain.

There were 33 patients with AAS, 2 with SMO process into the foramen magnum,

8 with SAS, and 8 with combinations of these. Preoperative reduction was

followed by decompression and fusion using wiring techniques and autologous

bone graft. Postoperative halo orthosis was provided for at least 3 months.

The mean follow-up was 8.3 +/- 6 years (SD). RESULTS: There were 31 patients

(61%) who underwent atlantoaxial arthrodesis, 17 patients (33%) who

underwent subaxial, and 3 patients (6%) who underwent occipitocervical

arthrodesis. During follow-up, 39% (13/33) of patients with AAS developed

nonsymptomatic (6) or symptomatic/unstable (7) SASs subsequent to C1-C2

fusion. The latter 7 patients (21%) subsequently required extension of their

arthrodesis. Adjacent segment disease was most common at the C3-C4

interspace after atlantoaxial fusion in 62% (8/13). Among the 8 patients who

underwent isolated cervical fusion for SAS, 1 patient (1/8, 12%) developed

adjacent instability after a fall and required extension of the previous

fusion. No secondary procedure was required for the 6 patients initially

stabilized by C1-(C6-T1) fusions for combinations of AAS + SAS. None of the

patients initially treated by C1-C2 arthrodesis for AAS progressed to SMO.

CONCLUSIONS: The incidence of subaxial instability in patients with

rheumatoid disease who underwent cervical arthrodesis may be higher than

previously reported, indicating the need for continued follow-up in these

patients. Adjacent segment disease may be most common at the C3-C4 level

following atlantoaxial fusion. Early stabilization of the C1-C2 complex in

the patients with AAS may potentially prevent progression of SMO.

PMID: 16876600

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=Abstra\

ctPlus & list_uids=16876600

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org