Neurological improvement and prognosis after occipito-thoracic fusion in patients with mutilating-type rheumatoid arthritis
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Mutilating-type rheumatoid arthritis, the most aggressive type of rheumatoid arthritis, is frequently associated with destructive cervical involvement, both at the high-cervical and subaxial levels, causing significant neurological deficit, and their natural course of the disease and the survival are discouraging. For such cases, we have been actively performing occipito-thoracic fusion since 1991. Although medical treatment for rheumatoid patients has represented a marked improvement, it could not treat all of these patients because of several reasons. Therefore, it is still important to evaluate the past treatment results.
We investigated the neurological improvement and prognosis in 51 mutilating-type rheumatoid arthritis patients who underwent occipito-thoracic fusion between 1991 and 2010. The neurological status was evaluated using modified Ranawat classification; class IIIB was subdivided into IIIBa (able to sit upright) and IIIBb (bedridden).
The preoperative neurologic status was IIIBa in 19 patients and IIIBb in 17 patients. 15 of the 19 patients with class IIIBa improved to being able to walk (79 %), whereas only 3 of the 17 patients with class IIIBb improved to being able to walk (18 %) after surgery. Of the 51 patients, 28 died during follow-up; the mean age at death was 67.2 years. The postoperative 5- and 10-year survival rates were 60.3 and 26.4 %, respectively.
The neurological improvement and prognosis after surgery was poorer in class IIIBb patients than in the other patient groups. Occipito-thoracic fusion can improve the neurological symptoms and prognosis. However, early surgical intervention is recommended, before a patient becomes bedridden (class IIIBb).
KeywordsRheumatoid arthritis Mutilating Cervical spine Occipito-thoracic fusion Prognosis
Conflict of interest
- 6.Shimizu T, Edakuni H, Iizuka H et al. (2000) Occipito-thoracic stabilization and fusion for myelopathic patients with destructive cervical disorders due to sever rheumatoid arthritis. In: 28th annual meeting of Cervical Spine Research Society Abstract book, pp 79–80Google Scholar
- 8.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 (14):1581–7 (discussion 1587)Google Scholar
- 10.Sunahara N, Matsunaga S, Mori T et al. (1997) Clinical course of conservatively managed rheumatoid arthritis patients with myelopathy. Spine 22 (22):2603–7 (discussion 2608)Google Scholar