Summary
One hundred consecutive patients with atlanto-axial dislocation(s) were subjected to posterior occipito-cervical fusion and followed up to 161/2 years postoperatively (mean: 41/2 years). The mean age at surgery was 60.3 years. At the time of follow-up, 45 patients had died, mostly due to cardiopulmonary disease. Out of the 100 patients, 67% showed a major improvement and in an additional 14% there was a slight or moderate improvement. Some patients with a stable fusion later developed subaxial dislocation(s) necessitating an anterior fusion which in patients with RA is difficult due to poor bone quality. MRI revealed pannus formation around the odontoid peg in many patients, in several to such a degree that cord compression was evident. Following the posterior fixation, the pannus disappeared or was reduced which may at least partly explain the generally favourable operative outcome following the fixation procedure. Early occipito-cervical fusion appears to prevent further vertical dislocation or upwards migration of the odontoid which is a more severe condition, and does not appear to result in increased incidence of subsequent subaxial dislocation(s). Such luxation(s) pose a technically difficult problem since the quality of the patients’ own bone usually does not permit a common anterior fusion procedure with autologous graft. In such cases with cord compression, acrylic cement may be used to obtain a normalized realignment.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Garrod AE (1890) A treatise on rheumatism and rheumatoid arthritis. C Griffin, London, pp 1–342
Ball J, Sharp J (1971) Rheumatoid arthritis of the cervical spine. In: Hill AGS (ed) Modern trends in rheumatology, vol 2. Butterworth, London
Bland JH (1974) Rheumatoid arthritis of the cervical spine. J Rheumatol 1: 319–342
Conlon PW, Isdale IC, Rose BS (1966) Rheumatoid arthritis of the cervical spine. Ann Rheum Dis 25: 120–126
Dirheimer Y (1977) The craniovertebral region in chronic inflammatory diseases. Springer, Berlin Heidelberg New York
Martel W, Page JW (1960) Cervical vertebral erosions and sub-luxations in rheumatoid arthritis and ankylosing spondylitis. Arthritis Rheum 3: 546–556
Smith PH, Benn RT, Sharp J (1972) Natural history of rheumatoid cervical luxations. Ann Rheum Dis 31: 431–439
Menezes AH, van Gilder JC, Graf CJ et al (1980) Craniocervical abnormalities. A comprehensive surgical approach. J Neurosurg 53: 444–455
van Gilder JC, Menezes AH (1982) Craniovertebral abnormalities and their treatment. In: Schmidek HH, Sweet WH (eds) Operative neurosurgical techniques, indications, methods, and results. Grune & Stratton, Orlamdo FL, London, pp 1221–1235
Brito N, Klawki P, Schwarz M, et al (1987) Late results in cases of atlanto-axial dislocations after dorsal fusion. In: Voth D, Glees P (eds) Diseases in the cranio-cervical junction. Walter de Gruyter, Berlin New York, pp 279–286
Mikulowski P, Wollheim FA, Rotmil P et al (1975) Sudden death in rheumatoid arthritis with atlanto-axial dislocation. Acta Med Scand 198: 445–451
Crockard HA, Essigman WK, Stevens JM et al (1985) Surgical treatment of cervical cord compression in rheumatoid arthritis. Ann Rheum Dis 44: 809–816
Redlund-Johnell I (1984) Dislocations of the cervical spine in rheumatoid arthritis. Doctoral Dissertation Lund LUMEDW/ MEXM-1001/1–140/ 1984
McAfee PC, Bohlman HH, Han JS et al (1986) Comparison of nuclear magnetic resonance imaging and computed tomography in the diagnosis of upper cervical spinal cord compression. Spine 11: 295–304
Brattström H, Granholm L (1972) Operative realignment and fixation of atlanto-axial dislocation in rheumatoid arthritis. Orthop Surg Traumatol, Excerpta Medica Int Congr Series 291: 407
Brattström H, Granholm L (1973) Chirurgie der Halswirbelsäule bei Patienten mit rheumatoider Arthritis. Orthopädie 2. Springer, Berlin Heidelberg New York, pp 118–120
Brattström H, Granholm L (1976) Atlanto-axial fusion in rheumatoid arthritis. Acta Orthop Scand 47: 619–628
Brattström H (1981) Surgery in atlanto-axial dislocation in rheumatoid arthritis. Reconstr Surg Traumat 18: 16–29. Karger, Basel
Brattström H, Brandt L, Ljunggren B (1987) Atlanto-axial dislocation in rheumatoid arthritis — signs and symptoms, radiographic pathology, operative techniques, and results. In: Voth D, Glees P (eds) Diseases in the cranio-cervical junction. de Gruyter Verlag, Berlin New York, pp 261–268
Stevens JM, Kendall BE, Crockard HA (1986) The spinal cord in rheumatoid arthritis with clinical myelopathy: a computed myelographic study. J Neurol Neurosurg Psychiatry 49: 140–151
Crockard HA, Pozo JL, Ransford AO et al (1986) Transoral decompression and posterior fusion for rheumatoid atlantoaxial subluxation. J Bone Joint Surg (Br) 68-B: 350–356
Toolanen G (1986) Rheumatoid atlanto-axial instability. Umeä University Medical Dissertation No 166
Meijers KAE, van Beusekom GT, Luyendijk W et al (1974) Dislocation of the cervical spine with cord compression in rheumatoid arthritis. J Bone Joint Surg 56-B: 668
Schürmann K (1987) Operative stabilization of atlanto-axial dislocation combined with cervical cord compression (myelopathy) in rheumatoid arthritis. In: Voth D, Glees P (eds) Diseases in the cranio-cervical junction. de Gruyter Verlag, Berlin New York, pp 249–259
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1988 Springer-Verlag
About this paper
Cite this paper
Zygmunt, S.C. et al. (1988). Realignment and Surgical Fixation of Atlanto-axial and Subaxial Dislocations in Rheumatoid Arthritis (RA) Patients. In: Isamat, F., Jefferson, A., Loew, F., Symon, L. (eds) Proceedings of the 8th European Congress of Neurosurgery, Barcelona, September 6–11, 1987. Acta Neurochirurgica, vol 43. Springer, Vienna. https://doi.org/10.1007/978-3-7091-8978-8_18
Download citation
DOI: https://doi.org/10.1007/978-3-7091-8978-8_18
Publisher Name: Springer, Vienna
Print ISBN: 978-3-7091-8980-1
Online ISBN: 978-3-7091-8978-8
eBook Packages: Springer Book Archive