Cervical discovertebral destruction, subaxial subluxation, and myelopathy in a patient with rheumatoid arthritis

Halla, James T.; Fallahi, Sohrab

doi:10.1002/art.1780240713

Cited by 8 publications

(5 citation statements)

References 16 publications

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“…Furthermore, in these patients, preparations for the difficult airway should be made just in case. Since the involvement of the cervical spine, especially the atlantooccipital joint, causes limited head and neck movements and the involvement of the temporomandibular joint leads to reduced mouth opening, the risk of encountering difficult airway is increased in the general anesthesia plan [2]. In our patient, neck movements were also significantly limited and mouth opening was reduced.…”

Section: Discussionmentioning

confidence: 67%

“…The risk of difficult intubation is increased in RA patients due to restricted head and neck movements and mouth opening. Moreover, the presence of spine involvement may cause difficulty in central neuraxial block administrations [1,2]. Pemphigus vulgaris is an autoimmune bullous disease of the skin and/or mucous membranes characterized by loose bullae and erosions [3].…”

Section: Introductionmentioning

confidence: 99%

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Bilateral infraclavicular block administration in a case of coexisting rheumatoid arthritis and pemphigus vulgaris

2020

Ann Clin Anal Med

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In this case report, we aimed to review the characteristics of anesthesia management in a patient with the diagnoses of rheumatoid arthritis and pemphigus vulgaris who was scheduled for bilateral elbow surgery. A 55-year-old patient followed up with the diagnoses of rheumatoid arthritis and pemphigus vulgaris who was scheduled to undergo bilateral proximal carpectomy and external fixation of the wrist. The patient was detailedly informed about the procedure to be performed and his written consent was obtained. Bilateral infraclavicular block was on the patient. No complications such as vascular puncture, pneumothorax, and LA toxicity developed. We are of the opinion that patients with the diagnoses of rheumatoid arthritis and pemphigus vulgaris should be evaluated well, and regional techniques should be preferred in appropriate surgeries.

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Section: Discussionmentioning

confidence: 67%

Section: Introductionmentioning

confidence: 99%

Bilateral infraclavicular block administration in a case of coexisting rheumatoid arthritis and pemphigus vulgaris

2020

Ann Clin Anal Med

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“…Synovial inflammation can lead to joint erosion and deterioration of periarticular soft tissues, which are integral for joint stability. Damage to ligaments and joints causes various forms of instability [1,2]. Cervical spine involvement in patients with RA is a common complication that often results in anatomical deformities, particularly those of the upper cervical spine [3], with radiological cervical spine involvement being present in up to 86% of all patients with RA [4,5].…”

Section: Introductionmentioning

confidence: 99%

Ten-Year Results of Reconstruction for Rheumatoid Cervical Spine Lesions and Occurrence Factor of Subaxial Subluxation

et al. 2019

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Study DesignRetrospective chart review.PurposeThis study evaluated long-term surgical outcomes of computer-assisted reconstruction using transarticular or cervical pedicle screws for cervical spine lesions caused by advanced rheumatoid arthritis (RA).Overview of LiteratureWe routinely employ C1–C2 transarticular and cervical pedicle screw instrumentation to reconstruct advanced and unstable RA cervical lesions. However, few reports are available on the long-term results of surgical reconstruction for rheumatoid cervical disorders, particularly regarding cervical pedicle screw fixation.MethodsSix subjects (all female) with RA cervical lesions who underwent atlantoaxial or occipitocervical fixation and were followed for at least 10 years were retrospectively studied. A frameless, stereotactic, optoelectronic, computed tomography-based image guidance system was used for correct screw placement. Variables including the Japanese Orthopaedic Association score, EuroQol, Ranawat value, and C2–C7 angle before and 2, 5, and 10 years after surgery were assessed along with the occurrence of subaxial subluxation (SAS).ResultsMean age at initial surgery was 58.2±7 years (range, 51–68 years), and mean follow-up period was 141±11 months (range, 122–153 months). Lesions included atlantoaxial subluxation (AAS, n=2) and AAS+vertical subluxation (n=4). Mean C2–C7 lordotic angle before and 2, 5, and 10 years after surgery was 20.1°±6.1°, 21.0°±4.0°, 18.8°±4.7°, and 17.8°±5.3°, respectively. SAS did not occur in cases maintaining the C2–C7 lordotic angle. In two cases where the C2–C7 lordotic angle declined from 5 years postoperatively, SAS occurred at the C2–C3 level in one and at the C4–C5 level in the other, both of which required reoperation.ConclusionsPatients with rheumatoid cervical lesions who undergo atlantoaxial or occipitocervical fixation using C1–C2 transarticular or pedicle screws carry a risk of SAS for up to 10 years postoperatively, which may require reoperation.

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“…Synovial inflammation can lead to joint erosions and erosions of periarticular soft tissues, which are integral for joint stability. Damage to ligaments and joints can cause different types of instability [1,2]. The involvement of the cervical spine in patients with RA is a common complication that often results in anatomical deformities, particularly those of the upper cervical spine [3].…”

Section: Introductionmentioning

confidence: 99%

Mid-term results of computer-assisted cervical reconstruction for rheumatoid cervical spines

Uehara

Takahashi

Ogihara³

et al. 2013

Journal of Orthopaedic Science

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Study Design. A retrospective single-center study. Summary and background.We routinely have used C1/2 transarticular and cervical pedicle screw fixations to reconstruct highly destructed unstable rheumatoid arthritis (RA) cervical lesions. However, there is little data on mid-term results of surgical reconstruction for rheumatoid cervical disorders, particularly, cervical pedicle screw fixation.Objectives. The purpose of this study was to evaluate the mid-term surgical results of computer-assisted cervical reconstruction for such lesions.Methods. Seventeen subjects (4 men, 13 women; mean age, 61  9 years) with RA cervical lesions who underwent C1/2 transarticular screw fixation or occipitocervical fixation, with at least 5 years follow-up were studied. A frameless, stereotactic, optoelectronic, CT-based image-guidance system, was used for correct screw placement.Variables including the Japanese Orthopaedic Association (JOA) score, Ranawat class, EuroQol (EQ-5D), atlantodental interval (ADI), and Ranawat values before, and at 2 and 5 years after surgery, were evaluated. Furthermore, screw perforation rates were evaluated.Results. The lesions included atlantoaxial subluxation (AAS, n = 6), AAS + vertical subluxation (VS, n = 7), and AAS + VS + subaxial subluxation (n = 4). There was significant neurological improvement at 2 years after surgery, as evidenced by the JOA scores, Ranawat class, and the EQ-5D utility weight. However, at 5 years after surgery, Conclusions. Subjects with rheumatoid cervical lesions who underwent C1-C2 transarticular screw fixation or occipitocervical fixation using a pedicle screw had significantly improved clinical parameters at 2 years after surgery. However, there was a deterioration of this improvement at 5 years post surgery.

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Cervical discovertebral destruction, subaxial subluxation, and myelopathy in a patient with rheumatoid arthritis

Cited by 8 publications

References 16 publications

Bilateral infraclavicular block administration in a case of coexisting rheumatoid arthritis and pemphigus vulgaris

Bilateral infraclavicular block administration in a case of coexisting rheumatoid arthritis and pemphigus vulgaris

Ten-Year Results of Reconstruction for Rheumatoid Cervical Spine Lesions and Occurrence Factor of Subaxial Subluxation

Mid-term results of computer-assisted cervical reconstruction for rheumatoid cervical spines

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