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Cervical spine manifestations of rheumatoid arthritis: a review

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Abstract

Rheumatoid arthritis (RA) is a progressive autoimmune inflammatory disease affecting 1% of the population with three times as many women as men. As many as 86% of patients suffering from RA have cervical spine involvement. Synovial inflammation in the cervical spine causes instability and injuries including atlantoaxial subluxation, retroodontoid pannus formation, cranial settling, and subaxial subluxation. While many patients with cervical spine involvement are asymptomatic, symptomatic patients often present with nonspecific symptoms resulting from inflammation and additional secondary symptoms that are due to compression of the brainstem, cranial nerves, vertebral artery, and spinal cord. Radiographs are the imaging modality used most often, while MRI and CT are used for assessment of neural element involvement and surgical planning. Multiple classification systems exist. Early diagnosis and treatment of cervical spine involvement is critical. Surgical management is indicated when patients experience symptoms from cervical involvement that result in biomechanical instability and, or a neurological deficit. Atlantoaxial instability managed with atlantoaxial fusion, retroodontoid pannus with neural element compression is managed with posterior decompression and atlantoaxial fusion or occipitocervical fusion. Cranial settling is managed can be managed with anterior decompression and posterior fusion or with dorsal only approaches. Subaxial subluxation is managed with circumferential fusion or posterior only decompression and fusion. Patients with atlantoaxial instability have better functional and neurologic outcomes. RA patients have higher complication rates and more frequent need for revision surgery than the general population of spine surgery patients.

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References

  1. McInnes IB, Schett G (2017) Pathogenetic insights from the treatment of rheumatoid arthritis. Lancet 389:2328–2337

    Article  CAS  PubMed  Google Scholar 

  2. Smolen JS, Aletaha D (2015) Rheumatoid arthritis therapy reappraisal: strategies, opportunities and challenges. Nat Rev Rheumatol 11:276–289

    Article  PubMed  Google Scholar 

  3. Das KK, Pandey S, Gupta S, Behari S (2020) Rheumatoid Cervical Myelopathy. In Surgery of the Cranio-Vertebral Junction. Springer, Cham 545–564

  4. Heinlen L, Humphrey M (2017) Skeletal complications of rheumatoid arthritis. Osteoporos Int 28:2801–2812

    Article  CAS  PubMed  Google Scholar 

  5. Mańczak M, Gasik R (2017) Cervical spine instability in the course of rheumatoid arthritis–imaging methods. Reumatologia 55:201

    Article  PubMed  PubMed Central  Google Scholar 

  6. Krauss WE, Bledsoe JM, Clarke MJ, Nottmeier EW, Pichelmann MA (2010) Rheumatoid arthritis of the craniovertebral junction. Neurosurgery 66:A83–A95

    Article  Google Scholar 

  7. Prezerakos GK, Casey AT (2019) Diagnostics and Treatment of C1/C2-Instability in Rheumatoid Arthritis. In Spine Surgery. Springer Cham 345–352

  8. Zhang T, Pope J (2015) Cervical spine involvement in rheumatoid arthritis over time: results from a meta-analysis. Arthritis Res Therapy 17:148

    Article  Google Scholar 

  9. Nguyen HV, Ludwig SC, Silber J, Gelb DE, Anderson PA, Frank L, Vaccaro AR (2004) Rheumatoid arthritis of the cervical spine. Spine J 4:329–334

    Article  PubMed  Google Scholar 

  10. Terashima Y, Yurube T, Hirata H, Sugiyama D, Sumi M (2017) Predictive risk factors of cervical spine instabilities in rheumatoid arthritis: a prospective multicenter over 10-year cohort study. Spine 42:556–564

    Article  PubMed  Google Scholar 

  11. Gillick JL, Wainwright J, Das K (2015) Rheumatoid arthritis and the cervical spine: a review on the role of surgery. Int J Rheumatol 2015:1–12

    Article  Google Scholar 

  12. Hunter TM, Boytsov NN, Zhang X, Schroeder K, Michaud K, Araujo AB (2017) Prevalence of rheumatoid arthritis in the United States adult population in healthcare claims databases, 2004–2014. Rheumatol Int 37:1551–1557

    Article  PubMed  Google Scholar 

  13. Symmons D, Barrett E, Bankhead C, Scott D, Silman A (1994) The incidence of rheumatoid arthritis in the United Kingdom: results from the Norfolk Arthritis Register. Rheumatology 33:735–739

    Article  CAS  Google Scholar 

  14. Naranjo A, Carmona L, Gavrila D, Balsa A, Belmonte MA, Tena X, Rodriguez-Lozano C, Sanmartí R, González-Álvaro I (2004) Prevalence and associated factors of anterior atlantoaxial luxation in a nation-wide sample of rheumatoid arthritis patients. Clin Exp Rheumatol 22:427–432

    CAS  PubMed  Google Scholar 

  15. Neva MH, Kaarela K, Kauppi M (2000) Prevalence of radiological changes in the cervical spine--a cross sectional study after 20 years from presentation of rheumatoid arthritis. J Rheumatol 27:90–93

    CAS  PubMed  Google Scholar 

  16. Yurube T, Sumi M, Nishida K, Miyamoto H, Kohyama K, Matsubara T, Miura Y, Sugiyama D, Doita M (2012) Incidence and aggravation of cervical spine instabilities in rheumatoid arthritis: a prospective minimum 5-year follow-up study of patients initially without cervical involvement. Spine 37:2136–2144

    Article  PubMed  Google Scholar 

  17. Zikou AK, Alamanos Y, Argyropoulou MI, Tsifetaki N, Tsampoulas C, Voulgari PV, Efremidis SC, Drosos AA (2005) Radiological cervical spine involvement in patients with rheumatoid arthritis: a cross sectional study. J Rheumatol 32:801–806

    PubMed  Google Scholar 

  18. Csaba O, Kardos Z, Kostyál L, Hodosi K, Tamási L, Bereczki D, Szekanecz Z (2020) cervical spine involvement in rheumatoid arthritis patients in the era of biologics: a real-life, cross-sectional MRI study. Rheumatol Int 1–7

  19. Wasserman BR, Moskovicich R, Razi AE (2011) Rheumatoid arthritis of the cervical spine. Bull NYU Hosp Joint Dis 69:136–148

    Google Scholar 

  20. Dreyer SJ, Boden SD (1999) Natural history of rheumatoid arthritis of the cervical spine. Clin Orthop Relat Res 366:98–106

    Article  Google Scholar 

  21. Oda T, Fujiwara K, Yonenobu K, Azuma B, Ochi T (1995) Natural course of cervical spine lesions in rheumatoid arthritis. Spine 20:1128–1135

    Article  CAS  PubMed  Google Scholar 

  22. Pellicci P, Ranawat CS, Tsairis P, Bryan WJ (1981) A prospective study of the progression of rheumatoid arthritis of the cervical spine. JBJS 63:342–350

    Article  CAS  Google Scholar 

  23. de Brito RS, Baldo DC, Andrade LEC (2019) Clinical and pathophysiologic relevance of autoantibodies in rheumatoid arthritis. Adv Rheumatol 59:1–13

    Article  Google Scholar 

  24. Volkov M, van Schie KA, van der Woude D (2020) Autoantibodies and B Cells: The ABC of rheumatoid arthritis pathophysiology. Immunol Rev 294(1):148–63

  25. Mikulowski P, Wollheim FA, Rotmil P, Olsen I (1975) Sudden death in rheumatoid arthritis with atlanto-axial dislocation. Acta Med Scand 198:445–451

    Article  CAS  PubMed  Google Scholar 

  26. Derksen V, Huizinga T, van der Woude D (2017) The role of autoantibodies in the pathophysiology of rheumatoid arthritis. Semin Immunopathol 39(4):437–446

  27. Chen Z, Bozec A, Ramming A, Schett G (2019) Anti-inflammatory and immune-regulatory cytokines in rheumatoid arthritis. Nat Rev Rheumatol 15:9–17

    Article  CAS  PubMed  Google Scholar 

  28. Joaquim AF, Ghizoni E, Tedeschi H, Appenzeller S, Riew KD (2015) Radiological evaluation of cervical spine involvement in rheumatoid arthritis. Neurosurg Focus 38:E4

    Article  PubMed  Google Scholar 

  29. Delamarter RB, Bohlman HH (1994) Postmortem osseous and neuropathologic analysis of the rheumatoid cervical spine. Spine 19:2267–2274

    Article  CAS  PubMed  Google Scholar 

  30. Jones M, Kaufmann J (1976) Vertebrobasilar artery insufficiency in rheumatoid atlantoaxial subluxation. J Neurol Neurosurg Psychiatry 39:122–128

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Mayer JW, Messner RP, Kaplan RJ (1976) Brain stem compression in rheumatoid arthritis. JAMA 236:2094–2095

    Article  CAS  PubMed  Google Scholar 

  32. Menezes AH, VanGilder JC, Clark CR, El-Khoury G (1985) Odontoid upward migration in rheumatoid arthritis: an analysis of 45 patients with “cranial settling”. J Neurosurg 63:500–509

    Article  CAS  PubMed  Google Scholar 

  33. Zeidman SM, Ducker TB (1994) Rheumatoid arthritis. Neuroanatomy, compression, and grading of deficits. Spine 19:2259–2266

    Article  CAS  PubMed  Google Scholar 

  34. Paus AC, Steen H, Røislien J, Mowinckel P, Teigland J (2008) High mortality rate in rheumatoid arthritis with subluxation of the cervical spine: a cohort study of operated and nonoperated patients. Spine 33:2278–2283

    Article  PubMed  Google Scholar 

  35. Casey AT, Crockard HA, Moskovich R, Ransford A, Stevens J, Bland J (1996) Surgery on the rheumatoid cervical spine for the non-ambulant myelopathic patient—too much, too late? Lancet 347:1004–1007

    Article  CAS  PubMed  Google Scholar 

  36. Mallory GW, Halasz SR, Clarke MJ (2014) Advances in the treatment of cervical rheumatoid: less surgery and less morbidity. World J Orthoped 5:292–303

    Article  Google Scholar 

  37. Bodakçi E, Cansu DÜ, Ertürk A, Çalişir C, Korkmaz C (2018) Can neck pain be an initial symptom of rheumatoid arthritis? A case report and literature review. Rheumatol Int 38:925–931

    Article  PubMed  Google Scholar 

  38. Oshima K, Sakaura H, Iwasaki M, Nakura A, Fujii R, Yoshikawa H (2011) Repeated vertebrobasilar thromboembolism in a patient with severe upper cervical instability because of rheumatoid arthritis. Spine J 11:e1–e5

    Article  PubMed  Google Scholar 

  39. Janssen I, Nouri A, Tessitore E, Meyer B (2020) Cervical myelopathy in patients suffering from rheumatoid arthritis—a case series of 9 patients and a review of the literature. J Clin Med 9:811

    Article  PubMed Central  Google Scholar 

  40. Conlon P, Isdale I, Rose B (1966) Rheumatoid arthritis of the cervical spine. An analysis of 333 cases. Ann Rheum Dis 25:120

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Lipson SJ (1989) Rheumatoid arthritis in the cervical spine. Clin Orthop Relat Res 239:121–7

  42. Puttlitz CM, Goel VK, Clark CR, Traynelis VC, Scifert JL, Grosland NM (2000) Biomechanical rationale for the pathology of rheumatoid arthritis in the craniovertebral junction. Spine 25:1607–1616

    Article  CAS  PubMed  Google Scholar 

  43. Stevens J, Cartlidge N, Saunders M, Appleby A, Hall M, Shaw D (1971) Atlanto-axial subluxation and cervical myelopathy in rheumatoid arthritis. QJM 40:391–408

    CAS  PubMed  Google Scholar 

  44. Bayer E, Elliott R, Bang M, Ross M, Tall M (2019) Atlantoaxial instability in a patient with neck pain and rheumatoid arthritis. J Spinal Cord Med 9:1–4

  45. Ahn JK, Hwang J-w OJ-M, Lee J, Lee YS, Jeon CH, Cha H-S, Koh E-M (2011) Risk factors for development and progression of atlantoaxial subluxation in Korean patients with rheumatoid arthritis. Rheumatol Int 31:1363–1368

    Article  PubMed  Google Scholar 

  46. Yan W, Liu T, Zhou X, Chen X, Yuan W, Jia L (2008) Clinical characteristics and diagnosis of rheumatoid arthritis of upper cervical spine: analysis of 71 cases. Zhonghua Yi Xue Za Zhi 88:901–904

    PubMed  Google Scholar 

  47. Sugita S, Chikuda H, Kadono Y, Ohtsu H, Takeshita K, Nishino J, Tohma S, Tanaka S (2014) Clinical characteristics of rheumatoid arthritis patients undergoing cervical spine surgery: an analysis of National Database of Rheumatic Diseases in Japan. BMC Musculoskelet Disord 15:203

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  48. Joaquim AF, Appenzeller S (2014) Cervical spine involvement in rheumatoid arthritis—a systematic review. Autoimmun Rev 13:1195–1202

    Article  PubMed  Google Scholar 

  49. Younes M, Belghali S, Kriâa S, Zrour S, Bejia I, Touzi M, Golli M, Gannouni A, Bergaoui N (2009) Compared imaging of the rheumatoid cervical spine: prevalence study and associated factors. Jt Bone Spine 76:361–368

    Article  Google Scholar 

  50. Zoli A, Priolo F, Galossi A, Altomonte L, Di FG, Cerase A, Mirone L, Magaro M (2000) Craniocervical junction involvement in rheumatoid arthritis: a clinical and radiological study. J Rheumatol 27:1178–1182

    CAS  PubMed  Google Scholar 

  51. Colebatch AN, Edwards CJ, Østergaard M, Van Der Heijde D, Balint PV, D'Agostino M-A, Forslind K, Grassi W, Haavardsholm EA, Haugeberg G (2013) EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis. Ann Rheum Dis 72:804–814

    Article  PubMed  Google Scholar 

  52. Reijnierse M, Breedveld F, Kroon H, Hansen B, Pope T, Bloem J (2000) Are magnetic resonance flexion views useful in evaluating the cervical spine of patients with rheumatoid arthritis? Skelet Radiol 29:85–89

    Article  CAS  Google Scholar 

  53. Sudoł-Szopińska I, Jans L, Teh J (2017) Rheumatoid arthritis: what do MRI and ultrasound show. J Ultrasonogr 17:5–16

    Article  Google Scholar 

  54. 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 61:1003–1010

    Article  CAS  PubMed  Google Scholar 

  55. Steinbrocker O, Traeger CH, Batterman RC (1949) Therapeutic criteria in rheumatoid arthritis. J Am Med Assoc 140:659–662

    Article  CAS  PubMed  Google Scholar 

  56. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO III, Birnbaum NS, Burmester GR, Bykerk VP, Cohen MD (2010) 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 62:2569–2581

    Article  PubMed  Google Scholar 

  57. Sokolove J, Strand V (2010) Rheumatoid arthritis classification criteria. Bull NYU Hosp Jt Dis 68:232–238

    PubMed  Google Scholar 

  58. Kourilovitch M, Galarza-Maldonado C, Ortiz-Prado E (2014) Diagnosis and classification of rheumatoid arthritis. J Autoimmun 48:26–30

    Article  PubMed  CAS  Google Scholar 

  59. Kaito T, Hosono N, Ohshima S, Ohwaki H, Takenaka S, Fujiwara H, Makino T, Yonenobu K (2012) Effect of biological agents on cervical spine lesions in rheumatoid arthritis. Spine 37:1742–1746

    Article  PubMed  Google Scholar 

  60. Neo M (2008) Treatment of upper cervical spine involvement in rheumatoid arthritis patients. Mod Rheumatol 18:327–335

    Article  PubMed  Google Scholar 

  61. Wolfs JF, Kloppenburg M, Fehlings MG, van Tulder MW, Boers M, Peul WC (2009) Neurologic outcome of surgical and conservative treatment of rheumatoid cervical spine subluxation: a systematic review. Arthritis Care Res 61:1743–1752

    Article  Google Scholar 

  62. Hohl JB, Grabowski G, Donaldson WF III (2011) Cervical deformity in rheumatoid arthritis. Semin Spine Surg 23(3):181–187

  63. Kauppi M, Leppänen L, Heikkilä S, Lahtinen T, Kautiainen H (1998) Active conservative treatment of atlantoaxial subluxation in rheumatoid arthritis. Br J Rheumatol 37:417–420

    Article  CAS  PubMed  Google Scholar 

  64. Oostveen JC, van de Laar MA, Geelen JA, de Graaff R (1999) Successful conservative treatment of rheumatoid subaxial subluxation resulting in improvement of myelopathy, reduction of subluxation, and stabilisation of the cervical spine. A report of two cases. Ann Rheum Dis 58:126–129

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Matsunaga S, Sakou T, Sunahara N, Oonishi T, Maeda S, Nakanisi K (1997) Biomechanical analysis of buckling alignment of the cervical spine: predictive value for subaxial subluxation after occipitocervical fusion. Spine 22:765–771

    Article  CAS  PubMed  Google Scholar 

  66. Shen FH, Samartzis D, Jenis LG, An HS (2004) Rheumatoid arthritis: evaluation and surgical management of the cervical spine. Spine J 4:689–700

    Article  PubMed  Google Scholar 

  67. Hamilton JD, Gordon M-M, McInnes IB, Johnston RA, Madhok R, Capell HA (2000) Improved medical and surgical management of cervical spine disease in patients with rheumatoid arthritis over 10 years. Ann Rheum Dis 59:434–438

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. Jacobs JW, Bijlsma JW, van Laar JM (2015) Glucocorticoids in early rheumatoid arthritis: are the benefits of joint-sparing effects offset by the adverse effect of osteoporosis? The effects on bone in the Utrecht study and the camera-II study. Neuroimmunomodulation 22:66–71

    Article  CAS  PubMed  Google Scholar 

  69. Van der Goes MC, Jacobs JW, Bijlsma JW (2014) The value of glucocorticoid co-therapy in different rheumatic diseases-positive and adverse effects. Arthritis Res Therapy 16:S2

    Article  Google Scholar 

  70. Khanna R, Dlouhy BJ, Smith ZA, Lam SK, Koski TR, Dahdaleh NS (2015) The impact of steroids, methotrexate, and biologics on clinical and radiographic outcomes in patients with rheumatoid arthritis undergoing fusions at the craniovertebral junction. J Craniovertebr Junct Spine 6:60

    Article  Google Scholar 

  71. Lewis L, ROBINSON RF, YEE J, HACKER LA, EISEN G (1953) Fatal adrenal cortical insufficiency precipitated by surgery during prolonged continuous cortisone treatment. Ann Intern Med 39:116–126

    Article  CAS  PubMed  Google Scholar 

  72. Imagama S, Oishi Y, Miura Y, Kanayama Y, Ito Z, Wakao N, Ando K, Hirano K, Tauchi R, Muramoto A (2010) Predictors of aggravation of cervical spine instability in rheumatoid arthritis patients: the large joint index. J Orthop Sci 15:540–546

    Article  PubMed  Google Scholar 

  73. Sunahara N, Matsunaga S, Mori T, Ijiri K, Sakou T (1997) Clinical course of conservatively managed rheumatoid arthritis patients with myelopathy. Spine 22:2603–2607

    Article  CAS  PubMed  Google Scholar 

  74. Ryu JI, Bak KH, Kim JM, Chun H-J (2017) Comparison of transarticular screw fixation and C1 lateral mass-C2 pedicle screw fixation in patients with rheumatoid arthritis with atlantoaxial instability. World Neurosurg 99:179–185

    Article  PubMed  Google Scholar 

  75. Paik S-C, Chun H-J, Bak KH, Ryu J, Choi K-S (2015) Unilateral C1 lateral mass and C2 pedicle screw fixation for atlantoaxial instability in rheumatoid arthritis patients: comparison with the bilateral method. J Korean Neurosurg Soc 57:460–464

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Ebraheim N, Rollins JR Jr, Xu R, Jackson WT (1996) Anatomic consideration of C2 pedicle screw placement. Spine 21:691–694

    Article  CAS  PubMed  Google Scholar 

  77. Madawi AA, Casey AT, Solanki GA, Tuite G, Veres R, Crockard HA (1997) Radiological and anatomical evaluation of the atlantoaxial transarticular screw fixation technique. J Neurosurg 86:961–968

    Article  CAS  PubMed  Google Scholar 

  78. Wright NM (2004) Posterior C2 fixation using bilateral, crossing C2 laminar screws: case series and technical note. Clin Spine Surg 17:158–162

    Google Scholar 

  79. Miyamoto H, Sumi M, Uno K (2013) Outcome of surgery for rheumatoid cervical spine at one institute over three decades. Spine J 13:1477–1484

    Article  PubMed  Google Scholar 

  80. Yurube T, Sumi M, Nishida K, Takabatake M, Kohyama K, Matsubara T, Ozaki T, Maeno K, Kakutani K, Zhang Z (2011) Progression of cervical spine instabilities in rheumatoid arthritis: a prospective cohort study of outpatients over 5 years. Spine 36:647–653

    Article  PubMed  Google Scholar 

  81. Yen Y-S, Chang P-Y, Huang W-C, Wu J-C, Liang M-L, Tu T-H, Cheng H (2014) Endoscopic transnasal odontoidectomy without resection of nasal turbinates: clinical outcomes of 13 patients. J Neurosurg Spine 21:929–937

    Article  PubMed  Google Scholar 

  82. Ito H, Neo M, Sakamoto T, Fujibayashi S, Yoshitomi H, Nakamura T (2009) Subaxial subluxation after atlantoaxial transarticular screw fixation in rheumatoid patients. Eur Spine J 18:869–876

    Article  PubMed  PubMed Central  Google Scholar 

  83. Kraus DR, Peppelman WC, Agarwal AK, DeLeeuw HW (1991) Incidence of subaxial subluxation in patients with generalized rheumatoid arthritis who have had previous occipital cervical fusions. Spine 16:S486–S489

    Article  CAS  PubMed  Google Scholar 

  84. Clarke MJ, Cohen-Gadol AA, Ebersold MJ, Cabanela ME (2006) Long-term incidence of subaxial cervical spine instability following cervical arthrodesis surgery in patients with rheumatoid arthritis. Surg Neurol 66:136–140

    Article  PubMed  Google Scholar 

  85. Yoshida G, Kamiya M, Yukawa Y, Kanemura T, Imagama S, Matsuyama Y, Ishiguro N (2012) Rheumatoid vertical and subaxial subluxation can be prevented by atlantoaxial posterior screw fixation. Eur Spine J 21:2498–2505

    Article  PubMed  PubMed Central  Google Scholar 

  86. Christensson D, Säveland H, Zygmunt S, Jonsson K, Rydholm U (1999) Cervical laminectomy without fusion in patients with rheumatoid arthritis. J Neurosurg Spine 90:186–190

    Article  CAS  Google Scholar 

  87. Olerud C, Larsson B-E, Rodriguez M (1997) Subaxial cervical spine subluxation in rheumatoid arthritis: a retrospective analysis of 16 operated patients after 1-5 years. Acta Orthop Scand 68:109–115

    Article  CAS  PubMed  Google Scholar 

  88. Abumi K, Kaneda K (1997) Pedicle screw fixation for nontraumatic lesions of the cervical spine. Spine 22:1853–1863

    Article  CAS  PubMed  Google Scholar 

  89. Casey AT, Crockard HA, Stevens J (1997) Vertical translocation. Part II Outcomes after surgical treatment of rheumatoid cervical myelopathy. J Neurosurg 87:863–869

    Article  CAS  PubMed  Google Scholar 

  90. Horowitz JA, Puvanesarajah V, Jain A, Li XJ, Shimer AL, Shen FH, Hassanzadeh H (2018) Rheumatoid arthritis is associated with an increased risk of postoperative infection and revision surgery in elderly patients undergoing anterior cervical fusion. Spine 43:E1040–E1044

    Article  PubMed  Google Scholar 

  91. Koyama K, Ohba T, Ebata S, Haro H (2016) Postoperative surgical infection after spinal surgery in rheumatoid arthritis. Orthopedics 39:e430–e433

    Article  PubMed  Google Scholar 

  92. Kahlenberg JM, Fox DA (2011) Advances in the medical treatment of rheumatoid arthritis. Hand Clin 27:11–20

    Article  PubMed  PubMed Central  Google Scholar 

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  1. Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 2210, Chicago, IL, 60611, USA

    Nathan A. Shlobin & Nader S. Dahdaleh

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Shlobin, N.A., Dahdaleh, N.S. Cervical spine manifestations of rheumatoid arthritis: a review. Neurosurg Rev 44, 1957–1965 (2021). https://doi.org/10.1007/s10143-020-01412-1

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