Spontaneous Atlanto-Axial Dislocation in Ankylosing Spondylitis and Rheumatoid Arthritis

Sharp, J.; Purser, D. W.

doi:10.1136/ard.20.1.47

Cited by 197 publications

(45 citation statements)

References 14 publications

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“…In 1961, Sharp and Purser 32 reported on the largest series of atlantoaxial subluxations in 22 patients with ankylosing spondylitis. In their series, the mean age at the time of diagnosis with atlantoaxial subluxation was 41 years and 3 months (range 28-61 years).…”

Section: Discussionmentioning

confidence: 99%

“…16,17,21,29,35,38 Most reports detailing the presentation and treatment of CVJ disease and ankylosing spondylitis are limited to case reports and small case series. [3][4][5][6]11,13,14,[18][19][20][21][22]28,31,33,34,36,37 In 1961, Sharp and Purser 32 reported on 22 patients with ankylosing spondylitis and atlantoaxial subluxation. Among these patients, the most common presenting signs and symptoms were pain, occipitocervical deformity, and neurological deficits.…”

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Ankylosing spondylitis of the craniovertebral junction: a single surgeon's experience

Albert¹,

Menezes²

2011

SPI

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Object The objective of this study was to describe a single surgeon's experience managing craniovertebral junction (CVJ) disease due to ankylosing spondylitis. Methods The authors undertook a retrospective review of the records of patients with CVJ disease due to ankylosing spondylitis who were evaluated and treated by the senior author. Charts were reviewed for symptoms and signs at presentation, radiography results, treatment, and outcome. In addition, some of the patients had pathology reports available for review. Results Eight patients with CVJ disease due to ankylosing spondylitis were identified who were evaluated by the senior author in the years 1990–2008. The most common presenting symptoms were neck pain (37.5%), cranial neuropathy (37.5%), and sensory disturbance (62.5%). On examination, the most common findings were limited cervical range of motion (37.5%), weakness (50%), and myelopathy (75%). Radiographic evaluation revealed atlantoaxial subluxation, retroodontoid pannus formation, basilar invagination, and bone erosion. Surgery was offered to all of the patients, 7 of whom underwent operations. In most cases, the treatment was transoral–transpalatopharyngeal decompression followed by occipitocervical fusion. One patient with a reducible lesion underwent dorsal fusion alone. Neurological outcomes were favorable overall. Conclusions The incidence of CVJ disease in patients with ankylosing spondylitis varies among reports. These cases are rare in most neurosurgery clinics. It is important to recognize that patients with ankylosing spondylitis are at risk for CVJ disease, similar to patients with rheumatoid arthritis. Principles common to the management of other CVJ pathologies apply to these patients as well.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Ankylosing spondylitis of the craniovertebral junction: a single surgeon's experience

Albert¹,

Menezes²

2011

SPI

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“…Sie sind unspezifisch, kommen auch häufig ohne jeglichen sonstigen pathologischen Befund an der HWS vor und sind umgekehrt in 25% der Fälle bei Patienten mit atlantodentaler Subluxation nicht vorhanden [18,123]. Mögli-cherweise ist dies zum Teil auf die systemische analgetische Therapie zurückzuführen [44].…”

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Die Zervikale Myelopathie als Komplikation der Rheumatoiden Arthritis

Arlt

Steinmetz

2004

Z Rheumatol

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Arthritis of the cervical spine with instability of the atlantodental joint is a typical and frequent complicaiton in rheumatoid arthritis. Subsequent cervical myelopathy is rare but usually a severe complication. There is no stringent correlation between arthritis of cervical spine an occurrence of cervical myelopathy. Cervical myelopathy is often difficult to discern from parallel multilating peripheral joint damage, which makes the diagnosis difficult. The decision between conservative and operative therapeutic intervention has to be based on subtle clinical, neurophysiological and radiological assessment and-in particular-requires exact analysis of the course of the underlying rheumatoid arthritis and myelopathy. In this diagnostic process close collaboration of rheumatologist, surgeon and neurologist is essential.

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“…Die subaxiale Halswirbelsäule ist durch Affektion der Gelenkfacetten, interspinalen Ligamente und Bandscheiben betroffen. Eine Erosion der Endplatten wurde bei 12% bis 15% und Subluxationen der Wirbelkörper bei 10% bis 20% gefunden (2,9,36,48). Insgesamt kommt es bei etwa 20% aller Patienten mit chronischer Polyarthritis zu Problemen im Bereich der Halswirbelsäule, wovon dann wiederum ca.…”

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Die okzipitozervikale Fusion bei chronischer Polyarthritis

1998

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This report will relate our experience with the y-plate, which we used in the treatment of 39 patients (32 women and 7 men) with a mean age of 62.6 years (range 47 to 79 years) between 1987 and 1994. All patients had rheumatoid arthritis. Occipitocervical fusion was indicated by instabilities within the occipitocervical region and in cases with additional basilar invagination and/or after transoral dens resection for decompression of the spinal cord. The length of the fusion depended on the pathological changes of the subaxial cervical spine. Before surgery, 35 patients suffered from strong and 4 patients from moderate pain in the neck and/or the back of the head. On a linear scale from 0 to 10, the pain was rated as 8:1 on average (range 4 to 10). 31 patients had an instability of the atlantoaxial region and 19 patients a basilar invagination of the odontoid. A cervical myelopathy was found in 20 cases. One surgeon fused the occiput to C2 in 22 cases, to C3-C5 in 8 cases and to C7-T2 in 9 cases. An important factor in this operation is the integration of atlantoaxial screws in order to resist the translational dislocation of C1/C2. In 13 patients a resection of the odontoid had to be performed to adequately decompress the spinal cord. A reduction of C2 without dens resection was performed in cases with reducible instability C1/2. 32 of the patients could be controlled with a minimum follow-up of 12 months (average 32.2 months, range 12 to 66 months). Out of the other 7, 6 patients had died. At the time of follow-up, the pain was rated as 2.3 on average (range 0 to 10). A myelopathy was present in 2 cases. Six patients required further operations on the cervical spine; 4 patients developed an instability at the level(s) below the fusion and an enlargement of the fusion to these levels has been performed. The fusion rate was 96.9%, despite breakage of the implant in 3 and a screw loosening in 2 patients. According to the criteria of Conaty, the result was satisfying in 25 (75%) and not satisfying in 8 patients (25%). These results show the effectiveness of the occipitocervical fusion with the y-plate in rheumatoid arthritis. A transoral dens resection is only indicated in cases with basilar invagination causing a compression of the spinal cord or in such cases where a compression caused by the dens or the retrodental pannus formation cannot be treated by a reduction of the second cervical vertebra alone.

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Spontaneous Atlanto-Axial Dislocation in Ankylosing Spondylitis and Rheumatoid Arthritis

Cited by 197 publications

References 14 publications

Ankylosing spondylitis of the craniovertebral junction: a single surgeon's experience

Ankylosing spondylitis of the craniovertebral junction: a single surgeon's experience

Die Zervikale Myelopathie als Komplikation der Rheumatoiden Arthritis

Die okzipitozervikale Fusion bei chronischer Polyarthritis

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