PMID: 8606562Apr 13, 1996Paper

Surgery on the rheumatoid cervical spine for the non-ambulant myelopathic patient-too much, too late?

Lancet
A T CaseyA O Ransford

Abstract

Opinions differ on the timing of surgery for rheumatoid arthritis patients with atlanto-axial subluxation. Some clinicians wait for development of neurological signs; others favour prophylactic fusion and decompression. We examined the results of surgery in relation to neurological state at the time of operation. 134 patients underwent surgery for rheumatoid involvement of the cervical spine, after development of objective signs of myelopathy. Surgical outcomes were examined prospectively in two groups-patients who were still ambulant at the time of presentation (Ranawat class III A) and patients who had lost the ability to walk (Ranawat class III B)-by means of neurological and functional grading systems in conjunction with standard measures of postoperative morbidity and mortality. 58% of the ambulant patients attained Ranawat neurological grades I or II compared with only 20% of the non-ambulant patients (p<0.0001). The non-ambulant group also fared worse in terms of postoperative complication rate, length of hospital stay, functional outcome, and ultimately survival. Radiologically, the non-ambulant patients were characterised by a smaller cross-sectional spinal cord area. The strong likelihood of surgical complications, th...Continue Reading

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Citations

Mar 21, 2007·International Orthopaedics·M Schmitt-SodyA Veihelmann
Oct 7, 2006·European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society·Jun TakahashiHiroyuki Kato
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Apr 5, 2008·European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society·Haku IizukaKenji Takagishi
Aug 13, 2011·European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society·Nobuhide OgiharaHiroyuki Kato
Jul 25, 2012·European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society·Go YoshidaNaoki Ishiguro
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