REVIEW - Treatment of upper cervical spine involvement in RA

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Mod Rheumatol. 2008 Apr 15. [Epub ahead of print]

Treatment of upper cervical spine involvement in rheumatoid arthritis patients.

Neo M.

Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto

University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507,

Japan.

The cervical spine, especially the upper cervical spine, is a common

focus of destruction by rheumatoid arthritis (RA). Because of its

potentially debilitating and life-threatening sequelae, cervical spine

involvement remains a priority in the diagnosis and treatment of RA.

Many studies show that early surgical intervention gives a more

satisfactory outcome. Surgery aims to establish spinal stability and

to prevent neurological deterioration and injury to the spinal cord,

leading to improved neurological function. The recent sophisticated

screw-rod-plate technique allows one to obtain a solid fixation of the

upper cervical spine with a high possibility of bone union even in RA

patients. Although surgery of the occipitoatlantoaxial region is a

challenge with many possibilities of serious complications, recent

advances in the surgical technique, complete understanding of the

anatomy, and precise preoperative evaluation have decreased

complication rates. Early consultation with a specialized spine

surgeon is mandatory once cervical involvement is suspected in an RA

patient because once the patient becomes myelopathic, the rate of

long-term mortality increases and the chance of neurological recovery

decreases.

PMID: 18414784

http://www.ncbi.nlm.nih.gov/pubmed/18414784

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Not an MD