Cervical spine fusion in rheumatoid arthritis.

Ranawat, Chitranjan S.; O’Leary, Patrick F.; Pellicci, Paul M.; Tsairis, Peter; Marchisello, Peter J.; Dorr, Larry

doi:10.2106/00004623-197961070-00006

Cited by 512 publications

(245 citation statements)

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“…The cervical disorders were atlanto-axial subluxation (AAS) in six cases, AAS and vertical subluxation of the atlas (VS) in three, subaxial subluxation (SAS) in four and AAS + VS + SAS in eight. According to Ranawat's classification [19], the neurological deficits were class 2 in five cases, class 3A in seven, and class 3B in nine. The Ranawat's classification is defined as follows; class 1, no neural deficit; class 2, subjective weakness with hyper-reflexia and dysesthesia; class 3A, objective findings of paresis and long-tract signs, but ambulation possible; class 3B, quadriparesis with resultant inability to walk or to feed oneself.…”

Section: Methodsmentioning

confidence: 98%

“…Occipital or cervical pain was classified into four grades according to Ranawat's criteria [19]: Grade 0, None; Grade 1, mild, intermittent, requiring only aspirin analgesia; Grade 2, moderate, cervical collar required; Grade 3, severe, pain not relieved by either aspirin or collar. Preoperative pain assessments were Grade 0 in one case, Grade 1 in seven cases, Grade 2 in eleven cases, and Grade 3 in two cases.…”

Section: Methodsmentioning

confidence: 99%

“…The most common disorders include atrantoaxial (C1/2) instability and subluxation in the mid-and lower-cervical spine [6,21]. These conditions sometimes cause myelopathy, severe pain, or both, either of which impairs the quality of life of RA patients [19]. In such cases, reconstruction surgery may be indicated.…”

Section: Introductionmentioning

confidence: 99%

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Computer-assisted screw insertion for cervical disorders in rheumatoid arthritis

et al. 2006

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To reconstruct highly destructed unstable rheumatoid arthritis (RA) cervical lesions, the authors have been using C1/2 transarticular and cervical pedicle screw fixations. Pedicle screw fixation and C1/2 transarticular screw fixation are biomechanically superior to other fixation techniques for RA patients. However, due to severe spinal deformity and small anatomical size of the vertebra, including the lateral mass and pedicle, in the most RA cervical lesions, these screw fixation procedures are technically demanding and pose the potential risk of neurovascular injuries. The purpose of this study was to evaluate the accuracy and safety of cervical pedicle screw insertion to the deformed, fragile, and small RA spine lesions using computer-assisted image-guidance systems. A frameless, stereotactic image-guidance system that is CT-based, and optoelectronic was used for correct screw placement. A total of 21 patients (16 females, 5 males) with cervical disorders due to RA were surgically treated using the image-guidance system. Postoperative computerized tomography and plane X-ray was used to determine the accuracy of the screw placement. Neural and vascular complications associated with screw insertion and postoperative neural recovery were evaluated. Postoperative radiological evaluations revealed that only 1 (2.1%; C4) of 48 screws inserted into the cervical pedicle had perforated the vertebral artery canal more than 25% (critical breach). However, no neurovascular complications were observed. According to Ranawat's classification, 9 patients remained the same, and 12 patients showed improvement. Instrumentation failure, loss of reduction, or nonunion was not observed at the final followup (average 49.5 months; range 24-96 months). In this study, the authors demonstrated that image-guidance systems could be applied safely to the cervical lesions caused by RA. Image-guidance systems are useful tools in preoperative planning and in transarticular or transpedicular screw placement in the cervical spine of RA patients.

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Section: Methodsmentioning

confidence: 98%

Section: Methodsmentioning

confidence: 99%

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Computer-assisted screw insertion for cervical disorders in rheumatoid arthritis

et al. 2006

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“…The Ranawat classification for neurological deficits and the Ranawat classification for pain [7] were used to evaluate myelopathy and pain, respectively, before surgery, after surgery, and at most recent follow-up ( Table 2).…”

Section: Clinical and Radiographic Evaluationmentioning

confidence: 99%

A retrospective study of congenital osseous anomalies at the craniocervical junction treated by occipitocervical plate-rod systems

et al. 2012

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Purpose To evaluate the effectiveness of posterior occipitocervical reconstruction using the anchors of cervical pedicle screws and plate-rod systems for patients with congenital osseous anomalies at the craniocervical junction. Methods Twenty patients with congenital osseous lesions who underwent posterior occipitocervical fusion using the anchors of cervical pedicle screws and plate-rod systems for reduction and fixation from 1996 to 2009 were reviewed. The lesions included os odontoideum, occipitalization of the atlas, congenital C2-3 fusion, congenital atlantoaxial subluxation, congenital basilar invagination and combined anomalies. The clinical assessment and the measurements of the images were performed preoperatively, postoperatively and at most recent follow-up. Results The combined deformity of flexion of the occipitoatlantoaxial complex and invagination of the odontoid process associated with congenital osseous lesions at the craniocervical junction was corrected by application of combined forces of extension and distraction between the occiput and the cervical pedicle screws. Preoperative myelopathy improved in 94.7 % patients. The mean Ranawat value, Redlund-Johnnell value, atlantodental distance, occiput (O)-C2 angle, and C2-C7 lordosis angle improved postoperatively and was sustained at most recent follow-up. The mean cervicomedullary angle improved from 129.3°preoperatively to 153.3°postoperatively. The mean range of motion at the lower adjacent motion segment remained unchanged at most recent follow-up. The fusion rate was 95 %. Conclusions The results of the present study indicate that posterior occipitocervical reconstruction using the anchors of cervical pedicle screws and plate-rod systems is an effective technique for treatment of deformities and/or instability caused by congenital osseous anomalies at the craniocervical junction.

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“…Although the involvement of the middle and lower cervical spine can cause subaxial instability, neurological deficits can occur at any time [4]. These disorders produce myelopathy and severe occipital/neck pain, and reduce the quality of life (QOL) of these patients [5][6][7]. Furthermore, these disorders occasionally lead to quadriplegia and respiratory muscle paralysis.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of clinical results and quality of life after surgical reconstruction for rheumatoid cervical spine

et al. 2013

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Cervical spine fusion in rheumatoid arthritis.

Cited by 512 publications

References 0 publications

Computer-assisted screw insertion for cervical disorders in rheumatoid arthritis

Computer-assisted screw insertion for cervical disorders in rheumatoid arthritis

A retrospective study of congenital osseous anomalies at the craniocervical junction treated by occipitocervical plate-rod systems

Evaluation of clinical results and quality of life after surgical reconstruction for rheumatoid cervical spine

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