European Spine Journal

, Volume 18, Issue 8, pp 1130–1134

The characteristics of bony ankylosis of the facet joint of the upper cervical spine in rheumatoid arthritis patients

  • Haku Iizuka
  • Masahiro Nishinome
  • Yasunori Sorimachi
  • Tsuyoshi Ara
  • Takashi Nakajima
  • Yoichi Iizuka
  • Kenji Takagishi
Original Article

Abstract

This study investigated the bony ankylosis of the upper cervical spine facet joints in patients with a cervical spine involvement due to rheumatoid arthritis (RA) using computed tomography (CT) and then examined the characteristics of the patients showing such ankylosis. Forty-six consecutive patients who underwent surgical treatment for RA involving the cervical spine were reviewed. The radiographic diagnoses included atlanto-axial subluxation in 30 cases, vertical subluxation (VS) in 10 cases, VS + subaxial subluxation in 3 cases and cervical spondylotic myelopathy in 3 cases. The patients were classified into two groups, those developing bony ankylosis or not and then the differences in the patient characteristics between the two groups was investigated. Furthermore, cervical spine disorders and surgeries were also evaluated in patients who demonstrated such bony ankylosis. The CT reconstruction image demonstrated bony ankylosis in 12 patients (group BA), and the remaining 34 cases (group NB) showed no bony ankylosis. The level at which bony ankylosis occurred was atlanto-occipital joint (AOJ) in eight cases, atlanto-axial joint (AAJ) in two cases and AOJ, AAJ in two cases. No differences were observed between the two groups (age P > 0.54, gender P > 0.39, duration of RA P > 0.72). There was a significant difference between two groups in the patients showing obvious neurological impairment (P = 0.017). In BA group, arthrodesis or decompression was adapted for a caudal region of bony ankylosis. In conclusion, bony ankylosis of the facet joint of the upper cervical spine was detected in 12 of 46 RA patients with involvement of the cervical spine who thus required surgery. These findings showed that the patients demonstrating such ankylosis showed severe cervical myelopathy. In addition, we suggest that the occurrence of bony ankylosis was a risk factor for instability of AAJ, and subaxial instability or stenosis.

Keywords

Atlanto-axial subluxation Vertical subluxation Bony ankylosis Rheumatoid arthritis 

References

  1. 1.
    Crockard A (1995) Surgical management of cervical rheumatoid problems. Spine 20:2584–2590PubMedCrossRefGoogle Scholar
  2. 2.
    Eulderink F, Meijers KAE (1976) Pathology of the cervical spine in rheumatoid arthritis: a controlled study of 44 patients. J Pathol 120:91–108. doi:10.1002/path.1711200205 PubMedCrossRefGoogle Scholar
  3. 3.
    Iizuka H, Sorimachi Y, Ara T et al (2008) Relationship between morphology of atlanto-occipital joint and other radiographic results in atlanto-axial subluxation patients due to RA. Eur Spine J 17:826–830. doi:10.1007/s00586-008-0659-0 PubMedCrossRefGoogle Scholar
  4. 4.
    Matsunaga S, Sakou T, Onishi T et al (2003) Prognosis of patients with upper cervical lesions caused by rheumatoid arthritis, comparison of occipitocervical fusion between C1 laminectomy and nonsurgical management. Spine 28:1581–1587. doi:10.1097/00007632-200307150-00019 PubMedCrossRefGoogle Scholar
  5. 5.
    Ranawat CS, O’Leary P, Pellicci P, Tsairis P, Marchisello P, Dorr L (1979) Cervical spine fusion in rheumatoid arthritis. J Bone Joint Surg Am 61:1003–1010PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Haku Iizuka
    • 1
  • Masahiro Nishinome
    • 1
  • Yasunori Sorimachi
    • 1
  • Tsuyoshi Ara
    • 1
  • Takashi Nakajima
    • 1
  • Yoichi Iizuka
    • 1
  • Kenji Takagishi
    • 1
  1. 1.Department of Orthopedic SurgeryGunma University Graduate School of MedicineMaebashiJapan

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