Surgical Outcome in Rheumatoid Ranawat Class IIIb Myelopathy

Abstract

A large subset of patients with CVJ rheumatoid myelopathy may reach Class IIIb. These patients have unique management considerations. Surgery (despite high morbidity) often remains the best therapeutic option available to them. Improvement of even one grade in their Ranawat score from Class IIIb to Class IIIa brought about by surgery confers on them a significant benefit in terms of their quality of life and survival.

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

“…To our knowledge, there have been only 2 studies that included analyses of type of spine surgery (anterior vs posterior) in RA patients. 7,30 Casey et al 7 reported the results of a prospective study involving 116 patients with vertical translocation, a Ranawat neurological classification of at least Class II, and a mean postoperative follow-up of 62.3 months. The choice of anterior-posterior combination vs posterior-only surgery was made based on whether the compression was predominantly anterior or posterior and if the translocation was reducible with traction.…”

“…In the same study, the authors also showed higher incidence of chest infection in the anterior-approach group, but the association was not statistically significant. Nannapaneni and colleagues 30 examined surgical outcome in patients with very poor preoperative neurological status (Ranawat Class IIIB) and a mean follow-up of 39 months. All the patients underwent halo placement before surgery, and if their subluxation was reducible, they had the posterioronly surgery.…”

“…30,33 In our review, a multivariate analysis of the effect of age, sex, surgical technique, and follow-up period was performed to analyze the influence of these factors on neurological improvement (Table 5). Despite the significant finding in the previous univariate analysis, we found that the surgical techniques were no longer significantly correlated with outcome when the mentioned factors were added.…”

Rheumatoid Arthritis of the Craniovertebral Junction: Surgical Strategies, Current Approach and Proposal of a New Therapeutic Algorithm

“…Regarding those subjects with advanced functional impairment (ranawat IIIA and IIIB), Casey, et al published an important study where they suggest that surgical treatment for terminal patients and patients with advanced disease is related to higher rates of morbimortality and a poor perspective for functional recovery [21]. On the other hand, Nannapaneni, et al reported results for different types of treatment in those patients with advanced disease and showed that, with surgical treatment, 60% of them were capable of ambulating again and all of them experienced some level of cervical pain relief and quality of life improvement [22]. In this way, the answer to those dilemmas is not clear yet, and one must take into ac-restricting an average of 30° of flexoextension, and 35° to 40° of neck lateral rotation [29].…”

Cervical spine involvement in adult patients with juvenile rheumatoid arthritis: Description of three cases

“…При разрушении зубовидного отростка может развиться задний АтА-подвывих. Прогрессирующая воспалительная деструк-ция боковых масс атланта и хроническая кра-ниоцервикальная нестабильность приводят к вертикальному смещению (краниальное расположение, базилярное внедрение или верхняя миграция) зубовидного отростка [14][15][16]. Зубовидный отросток движется к foramen magnum затылочной кости и за пре-делы ее границ.…”