Surgical aspects of the cervical spine in rheumatoid arthritis

Der Orthopäde
D Grob

Abstract

Approximately 20% percent of the patients with rheumatoid arthritis show pathology in the cervical spine. The translational instability between axis and atlas might be painful and leads in the long term to myelopathic changes due to chronic traumatization of the myelon. Ongoing osseous resorption of the lateral masses of the atlas cause upward migration of the dens into the foramen magnum. In the subaxial cervical spine, the inflammatory process causes instability and deformity. Neck pain is the most common indication for surgery, but neurological symptoms with myelopathy or radicular deficits might be the primary cause for surgery. Neurophysiological investigation is suitable to obtain objective results. Stabilization of the atlantoaxial segment is the most common procedure for treatment of atlantoaxial instability. It is performed by screw fixation technique from a posterior approach. In case of severe occipitocervical dislocation, the fixation has to be extended to the occiput. Persistent dislocation or compression by the dislocated dens has to be treated by transoral decompression. In the subaxial spine, instabilities may be treated by posterior plate fixation with lateral mass screws or pedicle screws. Concomitant nar-rowi...Continue Reading

References

May 1, 1986·The Journal of Bone and Joint Surgery. British Volume·H A CrockardW K Essigman
Mar 1, 1987·The Journal of Bone and Joint Surgery. British Volume·K OnoK Yamashita
Sep 1, 1993·The Journal of Bone and Joint Surgery. American Volume·S D BodenG R Rechtine
Feb 9, 2000·Journal of Orthopaedic Science : Official Journal of the Japanese Orthopaedic Association·D Grob
Nov 1, 2000·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·D Grob
Nov 15, 2001·Spine·J Harms, R P Melcher
Dec 1, 1993·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·D Grob

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Citations

Jan 25, 2006·Der Orthopäde·C E HeydeR Kayser
Aug 31, 2013·Der Orthopäde·R RadlR Windhager
Jun 28, 2006·Journal of Occupational Medicine and Toxicology·Gertrud KirchhoffRainer Maria Kichhoff
Nov 19, 2008·British Journal of Neurosurgery·M O KelleherC Bolger

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