Pannus regression after posterior decompression and occipito-cervical fixation in occipito-atlanto-axial instability due to rheumatoid arthritis: Case report and literature review

Landi, Alessandro; Marotta, Nicola; Morselli, Carlotta; Marongiu, Alessandra; Delfini, Roberto

doi:10.1016/j.clineuro.2012.04.018

Cited by 26 publications

(19 citation statements)

References 31 publications

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“…Since pannus formation is probably secondary to articular hypermobility, fusion of the affected joint can result in pannus regression (especially in cases with contrast enhancement). 20 Finally, MRI can evidence cervical stenosis even when there is no evident SAS. Patients with RA can present with subaxial stenosis due to inflammatory tissue in the anterior or posterior canal space, documented with contrastenhanced MRI.…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

Radiological evaluation of cervical spine involvement in rheumatoid arthritis

Af¹,

Ghizoni²,

Tedeschi³

et al. 2015

FOC

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Cervical spine involvement commonly occurs in patients with rheumatoid arthritis (RA), especially those with inadequate treatment or severe disease forms. The most common site affected by RA is the atlantoaxial joint, potentially resulting in atlantoaxial instability, with cervical pain and neurological deficits. The second most common site of involvement is the subaxial cervical spine, often with subluxation, resulting in nerve root or spinal cord compression. In this paper, the authors review the most commonly used plain radiographic criteria to diagnose cervical instabilities seen with RA. Finally, we discuss the advantages and disadvantages of cervical CT and MRI in the setting of cervical involvement in RA.

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Section: Magnetic Resonance Imagingmentioning

confidence: 99%

Radiological evaluation of cervical spine involvement in rheumatoid arthritis

Af¹,

Ghizoni²,

Tedeschi³

et al. 2015

FOC

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“…Several articles have shown that pannus regression is also possible with posterior stabilization despite anterior location of the pannus. 20,23,24,37,41,42 …”

Section: Discussionmentioning

confidence: 99%

Pooled data analysis on anterior versus posterior approach for rheumatoid arthritis at the craniovertebral junction

Chieng

Madhavan

Vanni

2015

FOC

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OBJECT Rheumatoid arthritis (RA) is one of the most debilitating autoimmune diseases affecting the craniovertebral junction (CVJ). Patients predominantly present with myelopathic symptoms and intractable neck pain. The surgical approach traditionally has been either a combined anterior and posterior approach or a posterior-only approach. In this article, the authors review pooled data from the literature and discuss the benefits of the two types of approaches. METHODS A search of the PubMed database was conducted using key words that describe spine deformities in RA and specific spinal interventions. The authors evaluated the neurological outcomes based on the Ranawat scale in both the groups through chi-square analysis. Multiple logistic regression was carried out to further examine for potential confounders. Any adverse sequalae resulting from either approach were also documented. Because all the procedures performed via a transoral approach in the analyzed articles also involved posterior fixation, for convenience of comparison, the combined procedures are referred to as “anterior approach” or “anterior-posterior” in the present study. RESULTS The search yielded 233 articles, of which 11 described anterior approaches and 14 evaluated posterior approaches. The statistical analysis showed that patients treated with a posterior approach fared better than those treated with an anterior (combined) approach. It was noted that those patients in whom the cervical subluxations were reducible on traction predominantly underwent posterior approaches. CONCLUSIONS CVJ instability is a serious complication of RA that requires surgical intervention. Although the anterior-posterior combined approach can provide direct decompression, it is associated with morbidity, and the analysis showed no statistically significant benefit to patients. In contrast, the posterior approach has been shown to provide statistically significant superiority with respect to stabilization and subsequent pannus reduction. Surgical approaches are undertaken based on the reducibility of subluxations with traction and the vector of compressive force. However, the choice of surgical approach should be based on the individual patient's pathology.

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“…Recently, authors have postulated that posterior-only approaches, as opposed to anterior or circumferential operations, may be sufficient for atlantoaxial pannus regression and symptom resolution [2,5,6]. In a recently published case report and review of the literature, Landi et al discussed the trend in posterior approaches for the surgical management of atlantoaxial rheumatoid pannus [6].…”

Section: Introductionmentioning

confidence: 95%

“…In a recently published case report and review of the literature, Landi et al discussed the trend in posterior approaches for the surgical management of atlantoaxial rheumatoid pannus [6]. The objective of this manuscript is to characterize the efficacy of posterior instrumented fusion in the surgical management of atlantoaxial rheumatoid pannus.…”

Section: Introductionmentioning

confidence: 97%