RESEARCH - Timing of cervical spine stablization and outcome in patients with RA

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Int Orthop. 2008 Aug;32(4):511-6. Epub 2007 Mar 20.

Timing of cervical spine stabilisation and outcome in patients with

rheumatoid arthritis.

Schmitt-Sody M, Kirchhoff C, Buhmann S, Metz P, Birkenmaier C,

Troullier H, Jansson V, Veihelmann A.

Department of Orthopaedic Surgery, Campus Grosshadern,

Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377,

Munich, Germany.

One complication of rheumatoid arthritis (RA) is the involvement of

the cervical spine (CS). Although prophylactic stabilisation is

recommended, the timing at which this should occur is poorly defined.

The aim of our study was to evaluate the course of neurological

symptoms in terms of the timing of surgery. A total of 34 patients

with RA and CS involvement were surgically stabilised. These patients

were classified using the Ranawat (RW) score both preoperatively and

at an average of 54 months post-operatively. For each patient, the

presence of atlantoaxial and subaxial subluxation as well as vertical

migration of the odontoid was recorded. The anterior atlantodental

interval was also assessed pre- and post-operatively. Improvement was

obtained in 20 patients, the clinical situation remained unchanged in

three patients and three patients manifested disease progression. In

terms of the RW score, the 16 patients with pre-operative RW grades

I-II showed no deterioration at the post-operative follow-up, with 13

of these patients showing an improvement; the 12 patients with

pre-operative RW grades IIIA-IIIB did not show any improvement of

neurological symptoms at follow-up, although seven of these patients

subjectively assessed the symptoms to be less severe after surgery;

three other patients showed a worsening of symptoms. Our results

suggest that preventive stabilisation of CS in RA leads to acceptable

results, although the complications of the surgery are obvious.

However, early operative treatment may delay the detrimental course of

cervical myelopathy in RA.

PMID: 17372732

http://www.ncbi.nlm.nih.gov/pubmed/17372732

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