Risk of the high-riding variant of vertebral arteries at C2 is increased over twofold in rheumatoid arthritis: a meta-analysis

Abstract

Rheumatoid arthritis (RA) might lead to atlantoaxial instability requiring transpedicular or transarticular fusion. High-riding vertebral artery (HRVA) puts patients at risk of injuring the vessel. RA is hypothesized to increase a risk of HRVA. However, to date, no relative risk (RR) has been calculated in order to quantitatively determine a true impact of RA as its risk factor. To the best of our knowledge, this is the first attempt to do so. All major databases were scanned for cohort studies combining words “rheumatoid arthritis” and “high-riding vertebral artery” or synonyms. RA patients were qualified into the exposed group (group A), whereas non-RA subjects into the unexposed group (group B). Risk of bias was explored by means of Newcastle-Ottawa Scale. MOOSE checklist was followed to ensure correct structure. Fixed-effects model (inverse variance) was employed. Four studies with a total of 308 subjects were included in meta-analysis. One hundred twenty-five subjects were in group A; 183 subjects were in group B. Mean age in group A was 62,1 years, whereas in group B 59,9 years. The highest risk of bias regarded “comparability” domain, whereas the lowest pertained to “selection” domain. The mean relative risk of HRVA in group A (RA) as compared with group B (non-RA) was as follows: RR = 2,11 (95% CI 1,47–3,05), I2 = 15,19%, Cochrane Q = 3,54 with overall estimate significance of p < 0,001. Rheumatoid arthritis is associated with over twofold risk of developing HRVA, and therefore, vertebral arteries should be meticulously examined preoperatively before performing craniocervical fusion in every RA patient.

Advances in surgical treatment for atlantoaxial instability focusing on rheumatoid arthritis: Analysis of a series of 67 patients

“…13 Particularly in those with RA, the surgical treatment of AAI is challenging, because RA patients with AAI may have poor bone mineral density 8,14 and a higher risk of vertebral artery injury due to a narrow C2 pedicle, 2,15,16 and a high-riding vertebral artery. 17 They are also at increased risk of complications and readmission. 18 However, improvements in surgical techniques mean that atlantoaxial fusion is widely performed as regular surgery at many institutes.…”

Prevalence of high-riding vertebral arteries and narrow C2 pedicles among Central-European population: a computed tomography-based study

“…As it was recently noted, the most commonly employed method of managing both post-traumatic and rheumatic craniovertebral dislocation is Goel-Harms C1 lateral mass-C2 pedicle screw placement [6,7]. This procedure has become a gold standard thanks to polyaxial screws that provide a solid bicortical purchase.…”

Prevalence of High-Riding Vertebral Arteries and Narrow C2 Pedicles Among Central-European Population: A Computed Tomography-Based Study

“…As it was recently noted, the most commonly employed method of managing both post-traumatic and rheumatic craniovertebral dislocation is Goel-Harms C1 lateral mass-C2 pedicle screw placement [7,6]. This procedure has become a gold standard thanks to polyaxial screws that provide a solid bicortical purchase.…”