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Computer-assisted screw insertion for cervical disorders in rheumatoid arthritis

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Abstract

To reconstruct highly destructed unstable rheumatoid arthritis (RA) cervical lesions, the authors have been using C1/2 transarticular and cervical pedicle screw fixations. Pedicle screw fixation and C1/2 transarticular screw fixation are biomechanically superior to other fixation techniques for RA patients. However, due to severe spinal deformity and small anatomical size of the vertebra, including the lateral mass and pedicle, in the most RA cervical lesions, these screw fixation procedures are technically demanding and pose the potential risk of neurovascular injuries. The purpose of this study was to evaluate the accuracy and safety of cervical pedicle screw insertion to the deformed, fragile, and small RA spine lesions using computer-assisted image-guidance systems. A frameless, stereotactic image-guidance system that is CT-based, and optoelectronic was used for correct screw placement. A total of 21 patients (16 females, 5 males) with cervical disorders due to RA were surgically treated using the image-guidance system. Postoperative computerized tomography and plane X-ray was used to determine the accuracy of the screw placement. Neural and vascular complications associated with screw insertion and postoperative neural recovery were evaluated. Postoperative radiological evaluations revealed that only 1 (2.1%; C4) of 48 screws inserted into the cervical pedicle had perforated the vertebral artery canal more than 25% (critical breach). However, no neurovascular complications were observed. According to Ranawat’s classification, 9 patients remained the same, and 12 patients showed improvement. Instrumentation failure, loss of reduction, or nonunion was not observed at the final follow-up (average 49.5 months; range 24–96 months). In this study, the authors demonstrated that image-guidance systems could be applied safely to the cervical lesions caused by RA. Image-guidance systems are useful tools in preoperative planning and in transarticular or transpedicular screw placement in the cervical spine of RA patients.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Shinshu University, School of Medicine, Matsumotoshi Asahi 3-1-1, Nagano, 390-8621, Japan

    Jun Takahashi, Isao Nakamura, Hiroki Hirabayashi & Hiroyuki Kato

  2. Department of Orthopaedic Surgery, Hokkaido Social Insurance Hospital, Sapporoshi Toyohiraku Nakanoshima Ichijyo, 8-3-18, Hokkaido, 062-8618, Japan

    Yasuhiro Shono

  3. Kamimura Clinic, Matsumotoshi Kotobuki Toyooka Ipponmatsu 595-17, Nagano, 399-0021, Japan

    Mikio Kamimura

  4. Department of Orthopaedic Surgery, Chigasaki Tokushukai Medical Center, Chigasakishi Saiwaityo 14-1, Kanagawa, 253-0052, Japan

    Sohei Ebara

Authors
  1. Jun Takahashi
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  2. Yasuhiro Shono
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  3. Isao Nakamura
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  4. Hiroki Hirabayashi
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  5. Mikio Kamimura
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  6. Sohei Ebara
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  7. Hiroyuki Kato
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Correspondence to Jun Takahashi.

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Takahashi, J., Shono, Y., Nakamura, I. et al. Computer-assisted screw insertion for cervical disorders in rheumatoid arthritis. Eur Spine J 16, 485–494 (2007). https://doi.org/10.1007/s00586-006-0234-5

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  • DOI: https://doi.org/10.1007/s00586-006-0234-5

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