Atlantoaxial immobilization in rheumatoid arthritis: a prophylactic procedure?

Grob, Dieter

doi:10.1007/s005860000174

Cited by 45 publications

(31 citation statements)

References 29 publications

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“…Regarding the results after C1/2 arthrodesis in AAS patients due to RA, Grob et al [3] noted that once atlantoaxial arthrodesis was achieved in AAS patients, the resolution of the inflammatory process with destruction of the lateral masses of the atlas prevented further deterioration with vertical cranial migration. Recent reports have evaluated the morphology of the upper cervical spine in RA patients using CT. Iizuka et al [4] evaluated the AOJ of AAS patients using a sagittal reconstruction view on CT and noted ankylosis of the AOJ in 5 of 26 surgical cases, and induced severe displacement between C1 and C2 in the neutral position, despite the fact that normal findings of AOJ showed a slight displacement before surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Grob et al [3] noted that atlanto-axial arthrodesis achieved by TSF can prevent a further deterioration of the vertical cranial migration due to the destruction of the lateral masses of the atlas in RA AAS patients. However, Fujiya et al [1] noted in 57 patients showing either isolated atlanto-axial instability or in combination with mild vertical subluxation treated by atlanto-axial arthrodesis (Brooks method), that superior migration of the odontoid process occurred in 4 patients (7%), while 2 patients required occipital-cervical fusion as a second procedure.…”

Section: Discussionmentioning

confidence: 99%

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Atlanto-axial joint of atlanto-axial subluxation patients due to rheumatoid arthritis before and after surgery, morphological evaluation using CT reconstruction

et al. 2010

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This study investigated the preoperative morphology and postoperative fusion of the atlanto-axial joint (AAJ) in patients with atlanto-axial subluxation (AAS) due to rheumatoid arthritis (RA) using computed tomography (CT). Furthermore, we examined the relationship between the preoperative morphology of AAJ and other radiographic results. Thirty patients with AAS due to RA treated by C1-2 transarticular screw fixation (TSF) were reviewed. The morphology of the AAJ was evaluated using sagittal reconstruction views on CT before and 1 year after surgery. Thereafter, the atlanto-dental interval (ADI) value at the neutral and maximal flexion position and atlanto-axial angle (AAA) at the neutral position was assessed in preoperative lateral cervical radiographs. The preoperative morphology of the AAJ on CT reconstruction

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Atlanto-axial joint of atlanto-axial subluxation patients due to rheumatoid arthritis before and after surgery, morphological evaluation using CT reconstruction

et al. 2010

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“…Once VS has occurred, permanent neurological deficit and mortality rate increase drastically, even after adequate surgery has been performed. Surgical consensus for AAS has been established regarding myelopathy or intractable cervical pain, and early atlantoaxial arthrodesis in patients with AAS may potentially prevent progression of VS [8,9]. However, the question of whether RA patients are at risk for developing VS and/or SAS after AAS treatment is controversial.…”

Section: Discussionmentioning

confidence: 99%

“…On this point, atlantoaxial fixation is widely accepted as the most effective option for AAS and potentially may prevent progression of VS and SAS. AA fixation has been proposed as a prophylactic procedure for VS, because the mechanical effect prevents the destruction of the lateral masses of the atlas from the inflammatory process [8]. On the contrary, fused mechanical limitations may occasionally become risk factors for SAS [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Rheumatoid vertical and subaxial subluxation can be prevented by atlantoaxial posterior screw fixation

et al. 2012

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Purpose Literature has described a risk for subsequent vertical subluxation (VS) and subaxial subluxation (SAS) following atlantoaxial subluxation in rheumatoid patients; however, the interaction of each subluxation and the radiographic findings for atlantoaxial fixation has not been described. The purpose of this study was to evaluate the effects of two different posterior atlantoaxial screw fixation on the development of subluxation in patients with rheumatoid atlantoaxial subluxation. Methods Between 1996 and 2006, rheumatoid patients treated with transarticular fixation and posterior wiring (TA) or C1 lateral mass-C2 pedicle screw fixations (SR) in the Nagoya Spine Group hospitals, a multicenter cooperative study group, were included in this study. VS, SAS, craniocervical sagittal alignment, and range of motion (ROM) at the atlantoaxial adjacent segments were investigated to determine whether posterior atlantoaxial screw fixation is a prophylactic or a risk factor for the development of VS and SAS. Results The mean follow-up was 7.2 years (4-12). No statistically significant difference was observed among the patients treated with either of the procedure during the follow-up period. Of 34 patients who underwent posterior atlantoaxial screw fixation, SAS was observed in 26.5 % during the follow-up period; however, VS was not observed. Postoperative C2-7 angle, and Oc-C1 and C2-3 ROM were significantly different between patients with and without postoperative SAS. The incidence of SAS was 38.9 % for TA and 12.5 % for SR; statistically significant differences were observed in the postoperative C1-2 and C2-7 angles, and C2-3 ROM. Conclusions Atlantoaxial posterior screw fixation may be an appropriate prophylactic intervention for VS and SAS if the atlantoaxial joint develops bony fusion following physiological alignment. Compared to TA, SR provided optimal atlantoaxial angle and prevented lower adjacent segment degeneration, thereby reducing SAS.

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“…Early surgery corrects AS and prevents further instability (Grob et al, 1999;Hamilton et al, 2001;McRorie et al, 1996). Early surgery may also reduce mortality (Grob, 2000;Paus et al, 2008;Tanaka et al, 2005). Posterior fusion reduces pain and may improve neurological symptoms or signs (Eyres et al, 1998;Matsunaga et al, 2003) as well as preventing progression of existing neural lesions without undue risk for the patient (Kim & Hilibrand, 2005;Santavirta et al, 1988).…”

Section: Discussionmentioning

confidence: 99%

Increased Mortality Rate in Rheumatoid Arthritis Patients with Neurological Symptoms or Signs Secondary to Cervical Spine Subluxations – Reduced Mortality if Postoperative Ankylosis is Achieved

Paus¹,

Steen²,

Mowinckel³

et al. 2012

Rheumatoid Arthritis - Etiology, Consequences and Co-Morbidities

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Atlantoaxial immobilization in rheumatoid arthritis: a prophylactic procedure?

Cited by 45 publications

References 29 publications

Atlanto-axial joint of atlanto-axial subluxation patients due to rheumatoid arthritis before and after surgery, morphological evaluation using CT reconstruction

Atlanto-axial joint of atlanto-axial subluxation patients due to rheumatoid arthritis before and after surgery, morphological evaluation using CT reconstruction

Rheumatoid vertical and subaxial subluxation can be prevented by atlantoaxial posterior screw fixation

Increased Mortality Rate in Rheumatoid Arthritis Patients with Neurological Symptoms or Signs Secondary to Cervical Spine Subluxations – Reduced Mortality if Postoperative Ankylosis is Achieved

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